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Emergency: requires immediate attention
Paraspinal abscess
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Emergency: requires immediate attention

Paraspinal abscess

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Paraspinal abscess is a collection of pus located around the spinal cord. This is usually seen as a complication of vertebral osteomyelitis and discitis (diskitis) but may be related to hematogenous seeding during bloodstream infection. Epidural catheters and injections may lead to direct inoculation of the epidural space. Frequently, the location of the abscess is in the epidural space.

The most common offending pathogens are gram-positive organisms, including Staphylococcus aureus. Gram-negative infections can occur and are often associated with ascending urinary sources. If epidemiologic risk factors are present, the clinician should also consider infection due to tuberculosis. Less common pathogens include Nocardia, Actinomyces species, and fungi.

Patients may have acute (develops over hours) or subacute (develops over weeks to months) back pain. Fever may or may not be present. As the abscess forms, patients typically have focal and severe back pain. As the size of the abscess increases, it may impinge on the spinal cord, leading to signs of spinal cord compression, including motor weakness and sensory deficits. Untreated, the patient's neurologic symptoms can worsen to the point of irreversible paralysis.

Diagnosis is typically made after the patient undergoes surgical drainage of the abscess. Infective material can be cultured to establish a diagnosis. Common laboratory findings include leukocytosis and elevation in inflammatory markers (sedimentation rate or C-reactive protein). Concomitant bloodstream infection may be present.

Risk factors include preceding back surgery, spinal surgery or instrumentation, back injury, and bacteremia. Patients at increased risk include injection drug users, immunosuppressed patients, and diabetics.

Codes

ICD10CM:
G06.1 – Intraspinal abscess and granuloma

SNOMEDCT:
11980001000004100 – Paraspinal abscess

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Degenerative bone disease of the spine – should not be associated with fever
  • Trauma to the spine – should not be associated with fever
  • Pyelonephritis – patients have fever and back pain (typically they have costovertebral angle tenderness)
  • Vertebral osteomyelitis – patients have fever and back pain
  • Metastatic tumor to the spine – back pain is also present
  • Meningitis (eg, bacterial, fungal) – neurological signs may include altered mental status or seizures but should not usually present with signs associated with spinal cord compression

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 10/31/2016
Last Updated: 04/27/2017
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Emergency: requires immediate attention
Paraspinal abscess
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Paraspinal abscess : Fever, Low back pain, Malaise, Muscle weakness, Paralysis, Urinary incontinence, WBC elevated, Lower extremity weakness
Imaging Studies image of Paraspinal abscess
Axial T1FS post-contrast MRI sequence demonstrates discitis osteomyelitis of the thoracic spine at T7-T8 with an associated paravertebral abscess. Note the extent of surrounding inflammatory changes in the paravertebral soft tissues - the non-enhancing portion corresponded to a fluid collection.
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