Spinal epidural abscess clinical features
Should be considered in a patient with back pain, fever, and spine tenderness
Spinal epidural abscess usually presents with excruciating pain localized over spine with tenderness to percussion.
Radicular symptoms follow with subsequent distal cord findings, often beginning with bowel/bladder disturbance, abdominal distension, weakness progressing to para- and quadriplegia. Average time is 3 days from back pain to root symptoms; 4.5 days from root pain to weakness; 24 hrs from weakness to paraplegia.
Fever, sweats or rigors are common, but are not always present 1).
A furuncle (skin boil) somewhere on the body may be identified in 15%.
Patients may be encephalopathic. This may range from mild to severe and may further delay diagnosis. Meningismus with a positive Kernig sign may occur.
Patients with postoperative SEA may demonstrate surprisingly few signs or symptoms (including lack of leukocytosis, lack of fever) aside from local pain 2)
Clinical signs, duration of symptoms and the rate of neurological deterioration show a high inter-individual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain.
In a study from 34 patients only three (42.9%) of the seven patients who died or acquired plegia presented with the three-symptom of spinal epidural abscess clinical features classic triad of fever, neurologic symptoms, and neck or back pain. 3).