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Spinal epidural abscess with cord compression — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsSpinal epidural abscess with cord compressionSCE Acute Medicine

A 36-year-old man presents with acute bilateral leg weakness and urinary retention. He has severe back pain after two days of fever and malaise. MRI spine shows a posterior epidural collection compressing the cord at T8. Blood cultures later grow Staphylococcus aureus. What is the most appropriate next step in management?

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Correct answer: D — Urgent neurosurgical decompression with intravenous antibiotics

Spinal epidural abscess with cord compression and neurological deficit requires urgent decompression plus IV antibiotics. Antibiotics alone may be considered in selected patients without deficit, but this patient has urinary retention and weakness. Lumbar puncture can worsen risk and does not treat the compression. The triad is often incomplete, so back pain with fever and neurology should trigger MRI.

Reference: NICE CKS spinal infection, BNF, neurosurgical emergency guidance