Absceso epidural espinal

A spinal epidural abscess is a pocket of infection and pus that builds up in the space between the back bones and the outer covering of the spinal cord. As it grows, it can squeeze the spinal cord and nerves, which may cause severe pain, weakness, or even paralysis if not treated quickly.

1) What is this condition?

It is an infection in the “epidural space” around the spinal cord, usually caused by bacteria carried in the blood or introduced by injections, surgery, or nearby infections.
Common early symptoms are severe, localized back pain, fever or chills, and sometimes feeling unwell; later, leg weakness, numbness, or bladder/bowel problems can appear.

2) How serious is it?

It is a medical emergency because the expanding abscess can permanently damage the spinal cord, leading to paralysis or loss of bladder/bowel control.
Even with modern treatment, reported complete recovery rates are only about 40–50%, and death rates around 10–20%, especially when diagnosis or treatment is delayed.

3) Non‑surgical treatments

High‑dose intravenous antibiotics tailored to the specific germ (often started broadly, e.g., MRSA‑active plus gram‑negative coverage, then narrowed when cultures return).
Typical antibiotic duration is at least 4–8 weeks to also cover nearby bone infection.
Careful monitoring in hospital of pain, temperature, blood tests, and especially any changes in strength, sensation, or bladder/bowel control.
Non‑surgical treatment alone is usually reserved for patients who have no or minimal nerve symptoms, are medically very high‑risk, or have small abscesses that can be watched closely.

4) Types of surgery that may be necessary

Urgent decompression and drainage:
- Laminectomy (removing part of the back of the vertebra) to open the canal, drain pus, and wash the infected space.
In some cases, additional stabilization (fusion with screws/rods) if bone is weak, unstable, or already involved by infection.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Eradicate infection with prolonged antibiotics when there is no or minimal cord compression and the person is closely monitored.
- Avoid the risks of major spine surgery in patients who are very frail or have stable neurologic status.
Surgery goals:
- Rapidly relieve pressure on the spinal cord and nerves, drain the abscess, and obtain cultures to guide precise antibiotic choice.
- Prevent or limit permanent paralysis, numbness, or bladder/bowel damage.

6) How surgery can “fix” the problem

By removing bone over the abscess and opening the epidural space, the surgeon can directly evacuate pus and infected tissue, instantly reducing pressure on the cord and nerves.
Samples taken at surgery help identify the exact bacteria, allowing antibiotics to be fine‑tuned for better effectiveness.
If the spine is unstable, screws and rods can be placed to hold the bones firmly while the infection is treated and the area heals.

7) Risks of surgery (general and specific)

General risks: bleeding, wound infection (on top of existing infection), blood clots, anesthesia and heart/lung complications.
Spine‑specific:
- Further injury to the spinal cord or nerves, which could worsen weakness, numbness, or bladder/bowel problems.
- Spinal fluid leak if the sac around the cord is opened, sometimes needing repair and longer hospital stay.

8) Chances this surgery will work

Emergency surgery within about 24 hours of significant weakness is linked to better neurologic improvement than delayed surgery or antibiotics alone.
Systematic reviews show around 60% of patients overall achieve “good” outcomes after combined surgery and antibiotics, though many still have some deficits.
People who are still walking or have only mild weakness at the time of surgery have the highest chance of full or near‑full recovery.

9) Possible complications from the surgery

Persistent or recurrent abscess if drainage is incomplete or antibiotics are interrupted, requiring repeat surgery.
Chronic pain, stiffness, or neurologic deficits (weakness, numbness, bladder/bowel dysfunction) even after adequate treatment, especially when treatment is delayed.
Long‑term reduced quality of life in a significant portion of survivors, especially those who had severe initial deficits.

10) Typical recovery from the condition

With prompt treatment, many patients experience substantial pain relief and stabilization or improvement of neurologic symptoms over weeks to months.
Those presenting late with severe paralysis or with major other illnesses may have only partial neurologic recovery and face prolonged rehab.

11) Typical recovery after surgery

Hospital phase: days to a few weeks of IV antibiotics, pain control, and early mobilization with close neurologic checks.
Subacute phase: continued IV or oral antibiotics (often 4–8 weeks total) plus physical and occupational therapy to restore walking and self‑care as much as possible.
Long‑term: gradual improvement over months; many patients plateau with some degree of residual weakness or pain, especially if initial damage was severe.

12) How long in the hospital

Hospital stays typically range from several days to a couple of weeks, depending on the severity of infection, neurologic status, and other medical problems.
Some patients move to inpatient rehab or skilled nursing while finishing IV antibiotics and intensive therapy.

13) Long‑term outlook

Overall, long‑term studies report complete neurologic recovery rates around 40–50% and mortality in the mid‑teens, even with appropriate treatment.
Prognosis depends heavily on: how early the condition is recognized, the degree of weakness at presentation, age, and other health issues (like diabetes, IV drug use, or immune problems).
Early diagnosis and rapid combined surgery plus antibiotics, when indicated, offer the best chance for a good outcome.

14) Need for outpatient follow‑up

Regular follow‑up with infectious‑disease and spine specialists to adjust antibiotics, monitor blood tests, and decide when to stop therapy.
Follow‑up MRI or other imaging in selected cases to ensure the abscess and any associated bone infection have resolved.
Long‑term rehab and primary care follow‑up to manage any residual neurologic deficits, pain, and to monitor for recurrence or new back/fever symptoms needing urgent re‑evaluation.