Iatrogenic spinal epidural abscess

Abstract

Background : Iatrogenic epidural abscess complicating neuro-axial blockade is rare, but carries significant morbidity and mortality if diagnosis is delayed. First documented in 1974, this disorder is now well described in the literature, and is increasing in incidence. Methods : A literature review was undertaken using Medline, all relevant papers on this rare, but important, complication of spinal epidural anesthesia or analgesia were used. Results : Widespread use of neuro-axial techniques in the peri-operative period such as epidural analgesia has probably contributed to improved surgical outcome but has also led to an increased incidence of complications. Epidural abscess or epidural catheter sepsis has previously been thought to occur rarely but recent publications suggest that it may be more frequent. Predisposing factors include old age, diabetes mellitus, alcoholism, cancer, and acquired immuno-deficiency syndrome. The signs and symptoms of epidural abscess may be nonspecific : including back pain, sepsis, with varying neurological deficits, which may present late. Magnetic resonance imaging (MRI) provides the most accurate definitive diagnosis. The treatment of choice in most patients is early neurosurgical decompression and antibiotic therapy. The most common causative organism in spinal epidural abscess is Staphylococcus aureus. Prompt diagnosis and specific therapy are the most important prognostic factors for a successful outcome. Conclusion : Iatrogenic spinal epidural abscess is a rare but serious complication which should be brought to the attention of all surgeons and anesthetists.