Spinal Epidural Abscess

More Back Pain

Step 1: View clinicals

An 82 year old woman presents with fever, diminished appetite and urinary incontinence for 10 days. She also gives a history of lower back pain and difficulty ambulating after a fall 3 weeks ago. Her co-morbidities are diabetes mellitus and hypertension, of which treatment details are unavailable. She lives alone. Her CBS is 250 mg/dl, while her FBC shows a WBC of 26,000 with 90% Neutrophils. Serum electrolytes are normal.


Step 2: Order all relevant investigations

X-Ray lumbosacral spine

The X-ray shows a wedge fracture of the T12 vertebra with involvement of the disc space.

X-Ray Chest

The chest x-ray appears normal.

Urinalysis

RBC: nil/hpf Pus cells: 1-2/hpf Gram stain: no organisms detected

MRI Spine

The T12 vertebra shows a wedge fracture and signs of osteomyelitis. There is a paraspinal soft tissue fluid collection from T12 to L1, with epidural extension and displacement of the underlying thecal sac.


Step 3: Select appropriate management

Corticosteroids
IV Antibiotics
Start Insulin
CT Guided Aspiration


Score: ★★☆