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Cervical Epidural Abscess

What is a Cervical Epidural Abscess?

An epidural abscess is a collection of fluid which contains bacteria. This bacterial is located outside of the lining of the spinal cord (). As the abscess enlarges and swells, it can potentially place pressure on the or , depending on its location.

What causes an Epidural Abscess?

An epidural abscess can happen due for the following reasons:

  1. Following spine surgery where bacteria were able to enter the spine.
  2. Depressed immune system, such as HIV disease, patients on chemotherapy, etc.
  3. Diabetes Mellitus especially when poorly controlled.
  4. Presence of a bacterial infection such as a Urinary Tract Infection or Lung Infection.
  5. Spread from another spine abscess
  6. Spread from an infection in spinal bones (vertebral osteomyelitis)
  7. No reason at all. Some patients get an epidural abscess without any apparent risk factors

What are the symptoms of a Cervical Epidural Abscess?

The following are possible symptoms of an epidural abscess in the spine:

  1. Feeling ill with fevers, chills, sweats, fatigue, nausea, lack of appetite
  2. Unusual sensations in the arms and/or legs
  3. Weakness in the arms and/or legs
  4. Difficulty with gait
  5. Pain in the spine at the level of the epidural abscess
  6. Headaches
  7. Severe neck pain and muscle spasms
  8. Inability to control bowel or bladder function

How do Spine Specialists make the diagnoses of a Cervical Epidural Abscess?

Spine specialists use information from the patient history, examination and special spine tests to make the diagnosis of an epidural abscess.

  1. History

A patient with a recent history of fevers, chills, sweats and severe neck pain causing numbness and weakness in the legs may have an epidural abscess which is compressing the spinal cord.

      2. Examination

Here are some examination techniques the doctor may be performing:

  1. Palpation (touch and pressure) over the spine
  2. Sensation testing (sensory) of the arms and legs
  3. Strength testing (motor) of the arms and legs
  4. Reflex testing of the arms and legs
  5. Kernig’s Sign
  6. Lhermitt’s Sign
  7. Hoffman’s Sign
  8. Ankle Clonus Test
  9. Babinski’s Sign

      3. Imaging

The diagnosis is often made with the help of imaging studies and laboratory tests:

A. X-Rays

X-Rays are not useful when looking for an epidural abscess.

B. MRI scans

MRI scans can show an epidural abscess quite clearly. The size of the abscess and its potential to cause compression of the spinal cord or spinal nerves can be seen. Often intravenous contrast material is given to be able to visualize the abscess better.

C. CT Scans

CT scans can show an epidural abscess but MRI is typically preferred.

D. Laboratory Studies

Typically blood cells are evaluated for the presence of infection with:

  1. Complete blood count with differential (CBC)

A Complete Blood Count (CBC) counts certain cells in the blood stream. When an infection is present, the number of White Blood Cells (WBC) will increase as they try to fight the infection. Some specific types of WBC’s can also be specifically elevated (Neutrophils) making the presence of an infection even more likely.

      2. C-Reactive Protein Count (CRP)

The CRP count is a measure of an inflammatory protein which increases when a severe inflammation or infection is present.

      3. Erythrocyte Sedimentation Rate (ESR)

The ESR is another measure which increases with a severe inflammation or infection.

How is a Cervical Epidural Abscess treated?

The treatment of an epidural abscess must occur quickly after recognizing the diagnosis. The main fear is that the abscess gets larger and begins to compress the spinal cord if not treated. There are two main treatments:

  1. Intravenous Antibiotics

Antibiotics given intravenously are typically given first. The most common bacteria causing an epidural abscess are called “”. Sometimes antibiotics alone can cure an epidural abscess.

      2. Surgical Care

An epidural abscess which is either causing compression of the spinal cord or spinal nerves, or one which does not respond to antibiotics is often treated with surgery. Typically the spine is opened and the infection washed out and removed. This is called a Cervical Laminectomy.