A patient developed fever and severe back pain following a surgery done under spinal anaesthesia. On examination a fluctuant swelling is noted at the site of spinal anesthesia. Non-contrast CT scan of the region showed a hypodense soft tissue mass and a diagnosis of epidural abcess is made. What is the treatment of choice in a case of epidural abscess?
Spinal epidural abcess is a neurosurgical emergency as neurologic deterioration to severe spinal cord dysfunction can occur in few hours. Decompressive surgery and drainage of the abcess is the initial step of management, followed by eradication of underlying infectious foci and administration of parenteral antibiotic. Patients with epidural abscess presents with fever, localised spinal tenderness, backache, raised ESR and raised white cell count. It most often occur due to hematogenous seeding and staphylococci is the most common etiologic agent.
Immediate surgical evacuation
Conservative management
Antibiotics
Aggressive debridement