What is a Spinal subdural Abscess?
Answers: Background: A spinal epidural abscess threatens the spinal cord by compression and also by vascular compromise (see Image 1). If untreated, an expanding suppurative infection in the spinal epidural space impinges on the spinal cord, producing sensory symptoms and signs, motor dysfunction, and, ultimately, paralysis and death. Intervention rash in the course of the disease undoubtedly improves the outcome. Frequently, the diagnosis is delayed because the initial presentation may be back torment alone or radicular symptoms with a chief complaint of chest pain or abdominal pain.
Pathophysiology: The spinal epidural space is not a uniform space. Posteriorly, the epidural space contains stout, small arteries, and the venous plexus. Infections in this space can and do spread over several vertebral levels. Anteriorly, the epidural space is a potential space with the dura tightly adherent to the vertebral bodies and ligaments. Abscesses go down more frequently in the larger posterior epidural space. Most spinal epidural abscesses occur contained by the thoracic area, which is anatomically the longest of the spinal regions.
Hematogenous spread with seeding of the epidural space is the suspected source of infection within most children and is thought to occur in many adults as capably. Reported sources of infection are numerous and include bacterial endocarditis, infected indwelling catheters, urinary tract infection, peritoneal and retroperitoneal infections, and others.
Direct extension of infection from vertebral osteomyelitis occurs in adults and rarely surrounded by children.
The source of infection is not identified in many patients.
The more clinically significant effects of the epidural abscess may be from involvement of the vascular supply to the spinal cord and subsequent infarction rather than direct compression. Staphylococcus aureus is the most commonly reported pathogen, though abundant other bacteria have been implicated, including Staphylococcus and Pseudomonas species, Escherichia coli, and Mycobacterium tuberculosis. Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly reported extremely in patients with spinal surgery or implanted devices.
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