skip to main content

Paravertebral Abscess Drainage Decision — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateBone & Joint InfectionParavertebral Abscess Drainage DecisionSCE Infectious Diseases

A 55-year-old man develops Staphylococcus aureus vertebral osteomyelitis with a paravertebral abscess. The abscess is 4 cm on MRI. He has back pain but no neurological deficit. Should the abscess be drained?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — CT-guided aspiration or drainage should be considered for abscesses >3 cm or those not responding to antibiotics — but small abscesses without neurological deficit may resolve with antibiotics alone; clinical judgement is needed

Paravertebral abscess management in vertebral osteomyelitis is nuanced: small abscesses (<3 cm) without neurological deficit often resolve with IV antibiotics alone. Larger abscesses (>3 cm), those failing medical therapy (persistent fever/raised CRP after 2–3 weeks), or those causing neurological compromise should be drained (CT-guided or surgical). A 4 cm abscess without neurological deficit falls into the grey zone — weekly MRI monitoring with antibiotics is reasonable initially, with drainage if no reduction in size by 2–3 weeks. Epidural extension with cord compression mandates emergency surgical decompression.

Reference: BSAC 2015 – Vertebral osteomyelitis; NICE NG157 2024; NICE CKS