Algorithm for the Management of Patients with Spinal Epidural Abscess Syndrome - Flowchart

Algorithm for the Management of Patients with Spinal Epidural Abscess Syndrome - Flowchart

Algorithm for the Management of Patients with Spinal Epidural Abscess Syndrome - Flowchart Spinal Epidural Abscess Spinal Epidural Abscess

«Flowchart»

Management of Patients with Spinal Epidural Abscess Syndrome
(Acute onset of back pain and spinal tenderness plus fever.)
(Higher integrative functions are intact, but neck stiffness may be present.)

Management of Patients with Spinal Epidural Abscess Syndrome
(Acute onset of back pain and spinal tenderness plus fever.)
(Higher integrative functions are intact, but neck stiffness may be present.)

Management of Patients with Spinal Epidural Abscess Syndrome
(Acute onset of back pain and spinal tenderness plus fever.)
(Higher integrative functions are intact, but neck stiffness may be present.)

Management of Patients with Spinal Epidural Abscess Syndrome

Acute onset or acute exacerbation of back pain, spinal tenderness, and fever

Acute onset or acute exacerbation of back pain, spinal tenderness, and fever

Acute onset or acute exacerbation of back pain, spinal tenderness, and fever

Obtain baseline blood cultures, WBC, and ESR

Obtain baseline blood cultures, WBC, and ESR

Obtain baseline blood cultures, WBC, and ESR

Obtain MRI of spine

Obtain MRI of spine

Obtain MRI of spine

Epidural mass present consistent with abscess?

Epidural mass present consistent with abscess?

Epidural mass present consistent with abscess?

Begin antimicrobials directed against most likely pathogens^*

Begin antimicrobials directed against most likely pathogens^*

Begin antimicrobials directed against most likely pathogens^*

^* ^*

Evaluate for other causes of back pain

Evaluate for other causes of back pain

Evaluate for other causes of back pain

Neurologic deficit?

Neurologic deficit?

Neurologic deficit?

Emergent neurosurgical intervention to decompress lesion and obtain samples for microbiology

Emergent neurosurgical intervention to decompress lesion and obtain samples for microbiology

Emergent neurosurgical intervention to decompress lesion and obtain samples for microbiology

Aspiration to obtain samples for microbiology

Aspiration to obtain samples for microbiology

Aspiration to obtain samples for microbiology

Consider conservative observation only if:

No neurologic deficit is present
and
Microbiologic etiology is firmly established
and
WBC and ESR fall rapidly on antibiotics
and
Excruciating pain resolves
and
Paraspinous fluid collections have been drained percutaneously (or if surgery is absolutely contraindicated for other reasons)

Consider conservative observation only if:

No neurologic deficit is present
and
Microbiologic etiology is firmly established
and
WBC and ESR fall rapidly on antibiotics
and
Excruciating pain resolves
and
Paraspinous fluid collections have been drained percutaneously (or if surgery is absolutely contraindicated for other reasons)

Consider conservative observation only if:

No neurologic deficit is present
and
Microbiologic etiology is firmly established
and
WBC and ESR fall rapidly on antibiotics
and
Excruciating pain resolves
and
Paraspinous fluid collections have been drained percutaneously (or if surgery is absolutely contraindicated for other reasons)

No neurologic deficit is present
and
and and
Microbiologic etiology is firmly established
and
and and
WBC and ESR fall rapidly on antibiotics
and
and and
Excruciating pain resolves
and
and and
Paraspinous fluid collections have been drained percutaneously (or if surgery is absolutely contraindicated for other reasons)

2 hours

2 hours

2 hours

End

End

End

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

No

No

No

^* If abscess drainage can be performed promptly, antimicrobial drugs may be withheld until specimens for microbial analysis are obtained.

^* If abscess drainage can be performed promptly, antimicrobial drugs may be withheld until specimens for microbial analysis are obtained.

^* If abscess drainage can be performed promptly, antimicrobial drugs may be withheld until specimens for microbial analysis are obtained.

^*