A spinal epidural abscess is a dangerous medical condition that can compress the spinal cord and cause permanent injury.
An abscess is an accumulation of pus caused by an infection. The epidural space is an area between the layers of the dura mater, which is the outermost protective layer of the spinal cord and brain. That epidural space contains fat for cushioning and small blood vessels called the internal vertebral venous plexuses.
When an infection spreads to the spinal epidural space and forms an abscess, it takes up space. As the abscess grows, it pushes up against bony vertebrae on the outer side. This leaves only one space where the abscess can expand–toward the spinal cord, where it reduces blood flow and compresses the cord.
Unfortunately, patients with a spinal epidural abscess are frequently misdiagnosed in the emergency room by emergency physicians, physician’s assistants, or nurse practitioners, or by hospital-based physicians, called hospitalists, once they’re admitted to the hospital.
Symptoms of spinal epidural abscess
The textbook symptoms of a spinal epidural abscess include:
• Pain in the neck or back not associated with trauma
• A loss of some neurological motor control or sensation
• A fever, recent infection, or dental procedure
When a patient has this pattern of symptoms, the standard of care requires the doctor or mid-level provider to consider the diagnosis of spinal epidural abscess and to order a stat (emergency) MRI to confirm or rule out the diagnosis.
Until a spinal epidural abscess is ruled out, a lumbar puncture (spinal tap) shouldn’t be considered because it could trigger herniation of the spinal cord in some severe situations.
Timing is important
Additionally, the standard of care requires ordering a consultation with a surgeon early on. In some situations, the only way to treat the condition and preserve neurological function is surgery to drain or remove the abscess and decompress the spinal cord.
When a spinal epidural abscess isn’t quickly diagnosed and treated, the problem can quickly evolve because of increasing damage caused by the growing abscess:
• It starts with back pain with tenderness on a physical exam.
• Next, it spreads to radiating pain caused by compression or irritation of nerve roots that may extend to the abdomen or chest or cause a burning or prickling sensation in the extremities (paresthesia).
• Then, it produces spinal cord compression, which can cause problems or impairments with movement (motor), sensation (sensory), or bowel or bladder dysfunction.
• Finally, it evolves into paralysis.
Doctors may commit medical malpractice by not recognizing the symptoms of a spinal epidural abscess until it’s too late or by ordering a CT scan, instead of an MRI scan, to make the diagnosis.
If you or a loved one has been seriously injured because of a spinal epidural abscess, then reach out to a top-rated, skilled Houston, Texas medical malpractice attorney for help in evaluating your potential case.
