Spinal Subdural Abscesses

Abstract

Spinal subdural abscess (or empyema) is a focal suppurative collection within the subdural space between the dura and the arachnoid layer. This rare infection of the central nervous system has high neurologic morbidity and even mortality and may be seen in both children and adults. Clinically, the triad of fever, back or radicular pain, and neurologic deficits are suggestive of the disease, though chronic forms tend to have less-specific symptoms that mimic those of spinal cord tumors. MRI with gadolinium injection is the investigation of choice. Staphylococcus aureus, Streptococcus species, and Mycobacterium tuberculosis are the microorganisms most likely to be found. The classic treatment of spinal subdural abscesses is surgical drainage of the suppurative collection followed by the administration of adequate antibiotic drugs. Conservative management is not appropriate. Good clinical recovery is correlated with prompt diagnosis, rapid surgical decompression and drainage, and appropriate antimicrobial therapy. Common complications include paraplegia, sphincter dysfunctions, recurrence, meningitis, sepsis, and even death.