Epidural infection

Spinal epidural abscess (SEA) following SCS implantation is rare but life-threatening. Early diagnosis is essential. Back pain is the most common clinical feature, and erythrocyte sedimentation rate and C-reactive protein levels are the most sensitive laboratory tests for an infection of this type. Staphylococcus aureusis the most common cause of SEA. Although several risk factors for SEA have been identified, the most common is diabetes mellitus. Proper surgical technique and compliance with evidence-based infection control procedures are essential to prevent infections related to SCS implantation, including SEA. Suspicion for a wound infection or SEA should be high in those with increasing back pain with or without fever. Contrast-enhanced MRI is the imaging study of choice in assessing SEA, although CT can be performed when MRI is contraindicated. Spondylodiscitis adjacent to SEA is common. Surgical evacuation of the abscess, explantation, and parenteral antibiotic therapy are key when the SEA is related to infected or contaminated spinal hardware or instrumentation.