The challenges of diagnosing a spinal epidural abscess

Spinal epidural abscess is a dangerous condition where an infection develops close to the spinal cord, causing a buildup of pus that becomes walled off, eventually compressing the spinal cord. It’s a rather rare condition that’s recently been reported to account for up to 5 out of every 10,000 hospital admissions each year in the United States.


There are two factors that make diagnosing a spinal epidural abscess challenging to doctors.

First, many of the early symptoms of a spinal epidural abscess are consistent with numerous other conditions. Here are some of the common ones:

• Headache

• Nausea and vomiting

• Fever

• An overall feeling of being tired or lethargic

• Back pain

As the spinal epidural abscess condition progresses, patients may develop symptoms that include:

• Difficulty walking or getting around

• Impaired coordination

• Altered mental status (acting in an unusual way)

• Bowel or bladder incontinence (loss of control)

• Paralysis

• Sepsis (a system-wide inflammatory condition after an infection)

The second challenging diagnostic factor for doctors, physician’s assistants, and nurse practitioners is that spinal epidural abscess is a relatively rare condition. That means if they don’t go through a proper differential diagnosis process to consider this dangerous diagnosis, they may settle on a more common, but incorrect, diagnosis. This can be devastating to patients.

Who’s at risk for a spinal epidural abscess?

One of the ways that doctors can overcome the trap of misdiagnosis is taking a careful patient history.

The history portion is something that a doctor should never delegate to someone else. It’s fine to have a patient fill out a form or have a nurse do an initial patient interview, but it’s no substitute for a physician having that question and answer time with the patient.

The whole point of the thorough patient history is for the doctor to obtain the information necessary to make the correct diagnosis. This would include risk factors that make the potential for spinal epidural abscess more likely.

While anyone could develop a spinal epidural abscess, the condition is most common in people age 60 and up. In addition, medical experts believe that these factors increase a person’s risk of getting this potentially disabling or life-threatening illness:

• Diabetes

• Compromised immune system


• Recent spine surgery or epidural anesthesia

• Any recent trauma to the spine

The diagnostic process

If the doctor concludes that a spinal epidural abscess is on the differential diagnosis list of potential causes for a patient’s symptoms, then the standard of care requires doing appropriate work up to rule it in or out.

Any workup, of course, starts with a thorough physical exam. In the case of a spinal epidural abscess, that would include a complete neurological exam to assess the patient’s:

• Motor function (ability to move the limbs)

• Sensation (ability to feel and sense things normally).

In addition, physicians would typically order blood work to look for signs of infection, such as an elevated white blood cell count, as well as an MRI or CT scan to look for an abscess.

The clock’s running

Before getting into the physician duties, it’s important to emphasize that nurses owe independent duties to patients. While a nurse can’t make a medical diagnosis or issue orders for medications or surgery, they are required to use their assessments and reassessments of patients to identify dangerous conditions. That’s when the critical nursing role is triggered, physician notification and advocacy.

Nursing advocacy involves direct communication to a doctor with important clinical information and recommendations. Advocacy can include requesting immediate physician evaluation of the patient and continuing to press for medical attention by invoking the chain of command if the doctor is unwilling to act in a way that the nurse considers to be in the best interest of the patient.

Once a physician determines that a spinal epidural abscess is one of the conditions that could explain the patient’s signs and symptoms, there is an urgency to get the workup done immediately. Time is of the essence because an undiagnosed, untreated spinal epidural abscess can lead to serious problems, including:

• Death

• Permanent brain paralysis because of spinal cord compression. If the abscess is in the cervical part of the spinal cord, it can lead to quadriplegia.

• Spinal infection or abscess

• Infection of the protective layers around the spinal cord, called meninges. This deadly condition is called meningitis.

Once the diagnosis is made through radiology testing or laboratory work, the standard of care requires the doctor to order aggressive antibiotic treatment to kill the infectious organism. It’s also often necessary to take the patient to the operating room for either surgical incision and drainage of the abscess or total removal of abscess.

If you’ve been seriously injured because of poor care related to spinal epidural abscess, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.