emDocs JULY 30, 2014 - By Stephen Alerhand
"Pearls
- Early diagnosis is the major prognostic factor for favorable outcome.
- Put SEA on the differential for spinal pain and with recent spinal instrumentation.
- Use risk factor assessment rather than “classic triad” exam screening.
- Perform full neurological exam including: reflexes, sensory and motor function, anal sphincter tone, ability to completely void—especially if patient is bed-bound or with other comorbidities. Focus on specific extremities/dermatomes corresponding to affected spine level.
- Consider ESR as screening tool in patients with spinal pain and a risk factor but without neurological deficits.
- Consider urgent MRI for high-risk patients with: neurological deficit and focal back pain, deficit and unexplained fever, deficit and elevated ESR, severe focal back pain and fever, severe focal back pain with markedly elevated ESR, unexplained extremely severe focal back pain. 16
- Advocate for your patient—early surgical intervention unless otherwise indicated."
http://www.emdocs.net/spinal-epidural-abscess/