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Epidural Infection

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Challenging Cases and Complication Management in Pain Medicine

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Abstract

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 aureus is 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.

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Author information

Authors and Affiliations

  1. Feinberg School of Medicine Northwestern University, Chicago, IL, USA

    David R. Walega M.D.

Authors
  1. David R. Walega M.D.
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Correspondence to David R. Walega M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois, USA

    Magdalena Anitescu

  2. Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

    Honorio T. Benzon

  3. Division of Pain Medicine, Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA

    Mark S. Wallace

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Walega, D.R. (2018). Epidural Infection. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_39

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  • DOI: https://doi.org/10.1007/978-3-319-60072-7_39

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60070-3

  • Online ISBN: 978-3-319-60072-7

  • eBook Packages: MedicineMedicine (R0)

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