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Post-Procedural Spinal Epidural Abscess — SCE Neurology MCQ

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HardCNS InfectionsPost-Procedural Spinal Epidural AbscessSCE Neurology

A 63-year-old with diabetes has fever, severe lumbar pain and rapidly progressive bilateral leg weakness with urinary retention. MRI shows an epidural collection compressing the cauda equina. Blood cultures have been taken. What is the most appropriate immediate management?

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Correct answer: C — Emergency decompression and drainage with sampling and intravenous antibiotics

A spinal epidural abscess causing rapidly progressive neurological deficit and cauda-equina compression is a surgical emergency because delay risks irreversible deficit. Urgent decompression and drainage can relieve neural compression and obtain material for microbiology; intravenous antibiotics should not be delayed in this unstable neurological context after appropriate cultures are taken. Image-guided biopsy and medical treatment alone are more plausible for selected neurologically intact, stable patients. Corticosteroids do not treat the infection and may worsen it.

Reference: Norfolk and Norwich University Hospitals NHS Foundation Trust, Infection of the Spine: https://www.nnuh.nhs.uk/departments/orthopaedic-amp-trauma/spine/infection-of-the-spine/