Spinal Epidural Abscess
February 20th, 2018Spinal Epidural Abscess (“SEA”) develops when an underlying infection – most commonly staphylococcus aureus – manifests itself as an abscess in the epidural space within the spinal column. This is considered a neurological emergency which can lead to irreversible neurological deficits if not treated promptly. While anyone can develop SEA, those most at risk include diabetics, IV drug users, and individuals who have a known source of infection.
The “classic triad” of symptoms traditionally associated with SEA includes fever, spine pain, and neurologic deficits. However, recent studies show that only a small percentage of SEA patients experience all three of these symptoms, and by the time the patient has a combination of spine pain, fever, and neurologic deficits, it is often too late for surgery to prevent permanent spinal cord injury. Darouiche, R. Spinal Epidural Abscess. The New England Journal of Medicine. 355;19:2006. This is why it is advocated that physicians consider SEA in any at risk patient with spine pain and fever or other indications of systemic infection. Davis, D. Prospective Evaluation of a Clinical Decision Guideline to Diagnose Spinal Epidural Abscess in Patients Who Present to the Emergency Department with Spine Pain. J Neurosurg Spine 14:765-770, 2011.
With some patients, the absence of a combination of fever and spine pain renders a health care provider’s failure to consider SEA understandable. In other cases, however, SEA is missed because the health care providers fail to think about the condition even in the presence of symptoms of SEA. In these cases, legal action may be warranted.
If there is suspicion for SEA, an MRI should be promptly obtained. Focus On: Spinal Epidural Abscess – Avoiding Neurologic Catastrophe in the ED. American College of Emergency Physicians. April 2010. MRI is reported to be 90% sensitive in diagnosing SEA. When diagnosed early, the prognosis is favorable. Mackenzie, A R. Spinal Epidural Abscess: The Importance of Early Diagnosis and Treatment. J Neurol Neurosurg Psychiatry 1998; 65:209-212. However, the condition can progress to cause spinal cord injury if not diagnosed and treated promptly. Epidural infection can injure the spinal cord either directly by mechanical compression or indirectly as a result of vascular occlusion caused by septic thrombophlebitis. Darouiche, pg. 2012-2013.
A four-stage system has been developed to track the progression of SEA: stage 1, back pain; stage 2, nerve root pain; stage 3, motor weakness, sensory deficit and/or bladder and bowel dysfunction; and stage 4, paralysis. Once diagnosed, treatment of SEA consists of neurosurgical referral for surgical drainage of the abscess and spinal decompression and antibiotic therapy. Some authorities have advocated treating SEA with antibiotics alone, but this approach is appropriate in only very limited situations. The mainstay of treatment for SEA is surgery plus antibiotics. Tuchman, A. The Indications and Timing for Operative Management of Spinal Epidural Abscess: Literature Review and Treatment Algorithm. Neurosurg Focus. Volume 37. 2014.
In summary, failure on the part of a physician to discover SEA can have catastrophic consequences. If treatment for SEA is delayed, permanent neurological deficits can emerge, including spinal cord injury and quadriplegia (tetraplegia). Failure to diagnose SEA prior to the onset of catastrophic neurological injury can give rise to a lawsuit to recover for damages such as past medical expenses, future medical care, and attendant care required for a neurologically impaired individual. SEA cases are challenging, but in the context of a lifelong permanent injury which will likely lead to substantial expenses during the lifetime of the victim, legal action to pursue substantial recovery may be warranted.
The Bowling Christiansen Law Firm has extensive experience handling cases involving spinal cord injury from a variety of causes, including SEA. Please contact us at (504) 586-5200 or email us at [email protected] for a free consultation.
