Epidural abscess is a localized suppurative inflammation in the epidural space of the spinal canal. The primary sources of infection can be nearby or distant boils, carbuncles, cellulitis, or other suppurative foci, as well as infections in various organs, or complications of systemic sepsis. Hematogenous spread is the most common route of infection. The predominant pathogen is Staphylococcus aureus. This condition can occur at any age, with equal incidence in males and females. Clinical manifestations primarily include systemic infection symptoms and signs of spinal cord dysfunction, with an acute and severe onset. Timely treatment often leads to a cure, whereas delayed diagnosis and treatment can result in severe disability or even death. Therefore, epidural abscess is generally considered a neurosurgical emergency.

bubble_chart Clinical Manifestations

1. Vertebral and radicular pain stage: The affected vertebra exhibits severe pain, accompanied by systemic symptoms such as fear of cold, high fever, and sometimes septicemia and meningeal irritation signs. If nerve roots are involved, radicular pain occurs. 2. Spinal cord dysfunction stage: Weakness and numbness in both lower limbs, sensory impairment below the lesion level, sphincter dysfunction, hyperreflexia in the lower limbs, positive pathological signs, and eventually complete transverse spinal cord damage, rapidly ascending from below. 3. Complete paralysis stage: Within hours to two days after spinal cord dysfunction appears, flaccid paralysis of both lower limbs quickly develops, with loss of sensation and reflexes, urinary retention, resulting in flaccid paralysis.

bubble_chart Diagnosis

1. History of suppurative infection. 2. The onset is usually acute, beginning with fear of cold, fever, and elevated white blood cell count, followed by severe spinal pain and localized radicular pain within a few days. 3. Tenderness and percussion pain are present in the spinous process and paravertebral area of the affected region, with pitting edema possibly appearing on the skin at the painful site. 4. Motor and sensory disturbances occur below the level of the lesion. 5. Purulent secretions are aspirated during epidural puncture at the affected segment. 6. CT and MRI scans reveal epidural abscess.

1. Once diagnosed, perform rapid decompression surgery to remove the source of spinal canal infection; 2. Apply sufficient broad-spectrum antibiotics both locally and systemically; 3. Prevent the occurrence of bedsore, pneumonia, and urinary tract infections; 4. Provide symptomatic supportive treatment.

Epidural abscess progresses rapidly, and limbs may become completely paralyzed within 1–2 days of onset. Surgical efficacy is directly related to the course of the disease and the degree of paralysis. If surgery is performed before complete paralysis occurs, paralysis can fully recover; however, if surgery is delayed until after flaccid paralysis develops, the outcome is extremely poor. Therefore, the key to improving treatment efficacy lies in early diagnosis and timely intervention. Patients with infection sources or systemic infection symptoms who exhibit limb numbness or weakness should promptly undergo relevant examinations to rule out epidural abscess. If diagnosed with epidural abscess, decompression surgery to remove the abscess should be performed as quickly as possible.

bubble_chart Cure Criteria

1. Cure: (1) Local inflammation and epidural abscess are cleared, systemic infection signs disappear; (2) Neurological function impairment signs significantly improve or return to normal. 2. Improvement: Local inflammatory lesions and systemic infection symptoms disappear, but neurological function impairment symptoms only improve or remain unchanged, requiring life care. 3. Not cured: Local inflammatory lesions and systemic infection symptoms are not completely resolved, neurological function impairment symptoms show no improvement, and the patient is unable to care for themselves.