Spinal Epidural Abscess After Corticosteroid Injections
Spinal Epidural Abscess After Corticosteroid Injections
Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.
Acute spinal epidural abscess (SEA) is encountered infrequently and accounts for 0.2 to 1.2 cases per 10,000 admissions to a referral center. Although it is described as a cause of back pain, the diagnosis is often overlooked and not considered initially unless the presentation is classical. Most cases of SEA are associated with previous spinal surgery, penetrating trauma, decubitus ulcer, osteomyelitis, or sepsis. A detailed history usually reveals a cause for interruption of the meningeal barrier. In general, patients have comorbid disease states such as diabetes or immunosuppression. In patients with a long-standing history of low back pain, epidural corticosteroid injections have shown good temporary benefit for control of pain. However, rare but potentially life-threatening complications may occur from this procedure. In the following case, SEA with vertebral osteomyelitis was not life-threatening but was probably due to corticosteroid injections.
Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.
Acute spinal epidural abscess (SEA) is encountered infrequently and accounts for 0.2 to 1.2 cases per 10,000 admissions to a referral center. Although it is described as a cause of back pain, the diagnosis is often overlooked and not considered initially unless the presentation is classical. Most cases of SEA are associated with previous spinal surgery, penetrating trauma, decubitus ulcer, osteomyelitis, or sepsis. A detailed history usually reveals a cause for interruption of the meningeal barrier. In general, patients have comorbid disease states such as diabetes or immunosuppression. In patients with a long-standing history of low back pain, epidural corticosteroid injections have shown good temporary benefit for control of pain. However, rare but potentially life-threatening complications may occur from this procedure. In the following case, SEA with vertebral osteomyelitis was not life-threatening but was probably due to corticosteroid injections.