Spinal epidural abscess: a review of epidemiology, diagnosis, and treatment

Despite advances in neuroimaging and neurosurgical treatment, spinal epidural abscess (SEA) remains a challenging problem for the practicing physician. Early diagnosis is often elusive, and treatment is delayed. The optimal management of SEA is not clearly defined, and morbidity and mortality remain significant. In this review article, we discuss contemporary issues surrounding SEA. In addition, we shed light on the epidemiology of this potentially devastating disease and outline current diagnostic and therapeutic guidelines. We find the frequency of diagnosis of SEA is increasing. To prevent serious morbidity and mortality, early diagnosis and prompt treatment are essential. Patients who are at high risk for developing such abscesses should have an immediate magnetic resonance scan with contrast enhancement. Surgical drainage and prolonged antibiotic use are the cornerstones of treatment, although selected patients may be treated nonsurgically with very vigilant medical follow-up.