Overview
A spinal epidural abscess can threaten the spinal cord or cauda equina by compressing the spinal cord or surrounding nerves and also by vascular compromise. If untreated, an evolving infection in the spinal epidural space can compress or impinge on the spinal cord, producing sensory dysfunction, motor dysfunction and ultimately progress to paralysis or death. Early recognition of this condition and appropriate treatment are keys to successfully treating a spinal epidural abscess and maximizing the patient’s chances for a successful outcome.
Medical literature indicates that approximately one-half of all spinal epidural abscess cases are misdiagnosed or have a delayed diagnosis.
Clinical Presentation
There is generally a four-phased sequential evolution of spinal epidural abscesses that has been observed in patients and reported in the medical literature:
- Localized spinal pain;
- Radicular pain (pain that radiates from the spine into other areas) and paresthesia;
- Muscular weakness, sensory loss and sphincter dysfunction; and
- Paralysis.
Localized back pain is often the first symptom in most patients. Radiating pain, including chest or abdominal pain, is not uncommon. Headache or neck pain may be present, especially with cervical epidural abscesses. With thoracic or lumbar epidural abscesses, sphincter dysfunction, including incontinence or increased residual urine volume can occur.
The patient’s physical findings can vary with the degree of spinal cord compression or dysfunction. As the infection progresses, motor and sensory level dysfunction can be identified on neurologic examination. Local tenderness on palpation or the presence of paraspinal muscle spasms may also be present. Early signs of spinal cord dysfunction can be identified, such as unilateral motor or sensory deficits or gait ataxia (unsteady or staggering walking). A patient’s reflexes may vary from being absent to hyperreflexia with clonus (rhythmic muscle spasms or contractions) and extensor plantar responses (a/k/a Babinski responses). Cervical epidural abscesses can cause nuchal stiffness (impaired neck flexion due to muscle spasm) or rigidity.
Potential Causes
Most cases of spinal epidural abscess are caused by a bacterial infection “seeding” in the epidural space from a distant source of infection within the body. Some possible sources of infection are skin and soft tissue infection, an infected catheter, bacterial endocarditis, respiratory tract infections, urinary tract infections or dental abscesses. Again, these are just some of the possible infectious causes of cervical or lumbar epidural abscesses.
If you or a family member have recently been diagnosed with a cervical epidural abscess or lumbar epidural abscess and you believe that there was a possible misdiagnosis or delay in diagnosing your spinal epidural abscess, please call our experienced medical malpractice team at Baldwin Matzus, LLC. We will investigate your case free of charge to determine if medical malpractice has occurred.
