Primary Spinal Epidural Abscess

Seven cases of primary spinal epidural abscess in children under age 12 have been reported; an additional case in a 2-year-old girl is presented. These infections, usually located in the dorsal epidural space of the mid thoracic or lower lumbar regions, are the result of hematogenous dissemination of bacteria, almost always penicillin-resistant Staphylococcus aureus, from foci of infection in the skin, or respiratory or urinary tracts. Early signs and symptoms are nonspecific, but eventually the patient shows signs of cord compression which vary with the location of the abscess. Laboratory studies suggest infection and the organism is sometimes isolated from blood cultures. Careful lumbar puncture should be done once the diagnosis of epidural abscess is suspected, followed by laminectomy and drainage as well as systemic antibiotics. Prognosis is excellent if surgery is performed before the development of neurologic deficit.