Spinal Epidural Abscess: A Review with Special Emphasis on Earlier Diagnosis.

Spinal epidural abscess (SEA) is an uncommon but serious condition with significant morbidity and mortality. The prognosis of SEA is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Unfortunately, often due to its nonspecific presentation, such as back pain, the diagnosis of SEA may be delayed in up to 75% of cases. Although many risk factors for SEA can be found in the published literature, their utility is limited by their frequent lack of objective evidence, numerousness, and absence in a significant proportion of cases. In this review, we call for a more discriminate evidence-based use of the term "risk factor" when discussing SEA and explore several approaches to its earlier diagnosis, including a simple algorithm based on its pathophysiology and serum C-reactive protein or erythrocyte sedimentation rate.

[Acute transverse myelopathy associated to S. aureus: a difficult differential diagnosis]. / Mielopatía transversa aguda asociada a S. aureus: la dificultad del diagnóstico diferencial.

Acute myelopathy includes a group of diseases with an important associated morbidity, thus early diagnosis and treatment is important. The most frequent etiology is extramedullary compression. Magnetic resonance (MR) is the most suitable procedure in this type of disease since it also offers information on extramedullar lesions and makes it possible to assess spine involvement. We present the case of a 57 year-old man who was admitted because of back pain for several weeks and systemic infection due to S. aureus. Later, he suffered a sudden neurological deficit with spine involvement but without compressive images on the MRI. We discuss the differential diagnosis among intramedullary abscess, epidural abscess, acute transverse myelitis and spondylodiscitis associated to acute myelopathy. We carry out a brief review of the medical literature on diagnosis criteria of those entities.

Facet joint injection: a rare form cause of epidural abscess formation.

The posterior zygo-apophyseal joints (facet joints) may be a significant source of back pain. Invasive treatment typically consists of injecting the joints with local anaesthetic and steroid or by radiofrequency ablation of the nerve supply to the joint. Facet joint injection is generally considered to be a very safe procedure with few significant side effects reported. Epidural abscess is a rare but potentially very serious occurrence. Most cases occur spontaneously but the condition may complicate epidural anaesthesia, spinal anaesthesia or epidural steroid injection. We report a case in which facet joint injections resulted in epidural abscess formation. To our knowledge this has not previously been reported.