Epidural Abscess

Overview

An epidural abscess is a pocket of infection and pus that forms in the small space between the bones of your spine and the protective covering around your spinal cord. This space is called the epidural space. Because the spinal cord and the nerves coming from it run through this area, an abscess here can press on them and cause serious problems. It is uncommon, but it needs urgent medical care.

No, it is uncommon. Most people with back pain do not have an epidural abscess. Doctors see it in a small number of people each year, often in people who have certain risk factors.

It can affect people of any age, but it is seen most often in adults over 50. It is more likely in people with diabetes, a weakened immune system, recent spine surgery or spine injections, a serious skin or blood infection, or a history of injecting drugs.

Symptoms

Common symptoms

• Back pain that is often severe and in one spot, and may get worse over hours or days
• Fever, chills, or feeling hot and shivery (though some people do not get a fever at all)
• Soreness when the spine is pressed or tapped, or pain that wakes you at night
• Feeling generally unwell, tired, or 'flu-like'
• Numbness, tingling, or weakness in the arms or legs
• Trouble starting to pee, or not being able to hold your pee or poo

Symptoms in children

• Fever with back or neck pain, or a child who cries when picked up or moved
• Refusing to walk, limping, or being very still because movement hurts
• Being unusually sleepy, grumpy, or hard to settle
• In babies, poor feeding, irritability, and a stiff or arched back

Symptoms in older adults

• New confusion or sleepiness, which can be the main clue
• Back pain that is put down to arthritis or 'a bad back' but is getting worse
• New weakness in the legs, unsteadiness, or falls
• New problems with bladder or bowel control
• Fever may be mild or missing, so the infection can be harder to spot

Causes

Main causes

• Bacteria reaching the spine through the bloodstream from an infection somewhere else, such as the skin, urine, mouth, or heart
• Infection spreading from nearby tissue, such as an infected spinal bone, a deep wound, or a pressure sore on the back
• Infection after a spinal procedure, such as spine surgery, an epidural injection, or the placement of a spinal drip or pain-relief tube
• Injury or damage to the spine that lets bacteria settle in the area

Risk factors

• Diabetes, especially if blood sugar is often high
• A weakened immune system, from illness or from medicines that calm the immune system
• Recent spine surgery, epidural injection, or spinal pain-relief tube
• A current infection elsewhere, such as a skin boil, urine infection, or infected tooth
• Using injected drugs
• Long-term steroid medicines
• Kidney problems, heavy alcohol use, or poor nutrition
• Older age, and being male

When to see a doctor

See a doctor urgently if:

• You have back pain along with a fever, chills, or feeling very unwell
• You have new numbness, tingling, or weakness in your arms or legs
• You are having trouble peeing, or you have leaked urine without meaning to
• You have had recent spine surgery or a spinal injection and your back pain is getting worse
• Your back pain is severe and came on over hours or a few days rather than weeks

Book a routine appointment if:

• Long-standing back pain that is not getting worse and comes with no fever or weakness
• A small skin infection or boil that is not healing, so it can be treated early
• A general check-up if you have diabetes and your blood sugar has been hard to control
• Questions about your recovery after spine surgery or a spinal injection

Diagnosis

A doctor will ask about your symptoms and examine you, including feeling and tapping along your spine and checking the strength and feeling in your arms and legs. If they suspect an epidural abscess, they will arrange urgent tests, usually in hospital. A scan is the key test, because it shows exactly where the infection is and how much it is pressing on the spinal cord and nerves.

Tests that may be done

• A physical and nerve examination, checking strength, feeling, reflexes, and how your bladder is working
• Blood tests to look for signs of infection and inflammation
• Blood cultures, where a small blood sample is tested to see whether bacteria are growing and which type they are
• An MRI scan of the spine, usually with a special dye, which is the best way to see an abscess
• A CT scan if MRI cannot be used straight away
• Sometimes a small sample of fluid taken with a fine needle, guided by a scan, to identify the bacteria

What to expect at your appointment

You may be seen in hospital quickly and started on antibiotic treatment before all the results are back, because waiting can be risky. This is a normal and sensible step. The scan itself is painless, though you need to lie still for a while. Results usually come back within hours to a few days, and your team will explain what they find.

Treatment

An epidural abscess is treated in hospital, and treatment usually starts quickly. The aim is to kill the infection, relieve pressure on the spinal cord and nerves, and protect your ability to move, feel, and control your bladder and bowel. Most people need a combination of antibiotics and, in many cases, surgery.

Self-care at home

• Take all medicines exactly as prescribed and finish the full course, even if you feel better
• Keep every follow-up appointment, including blood tests and any repeat scans
• Follow your team's advice on how much to rest and when to start gentle movement
• Keep any wound clean and dry, and know the signs of infection to watch for
• Tell any doctor or dentist treating you that you have had an epidural abscess
• Ask for help with everyday tasks while you recover, and accept it

Medical treatments

The main treatment is antibiotics, usually given into a vein through a drip in hospital for several weeks. Your team may later switch you to tablets to finish the course. Which antibiotic is chosen depends on the bacteria found or suspected. You will also be given pain relief and close monitoring of your nerves, movement, and bladder and bowel function. A physiotherapist and nurse team will support your recovery. Your doctors will watch you closely and adjust the plan if your symptoms change.

When is surgery considered?

Many people need an operation to drain the pus and take pressure off the spinal cord and nerves. Surgery is usually recommended when there is pressure on the spinal cord, when nerves are affected, when antibiotics alone are not working, or when the infection is large. Some people with early or mild infection, or who cannot have surgery safely, are treated with antibiotics alone under close watch. Your medical team will explain which approach suits you.

Living with this condition

Recovery takes time. Many people spend weeks in hospital followed by a period of rehabilitation at home, with physiotherapy to rebuild strength and movement. Tiredness is common at first. Build your activity up slowly, plan rest into your day, and let family or friends help with shopping, cooking, and travel. Keep a simple note of any new symptoms so you can tell your care team.

Lifestyle tips

• Take medicines as prescribed and keep all appointments
• Work on steady, gentle activity as advised by your physiotherapist
• If you have diabetes, keep your blood sugar as stable as you can
• Avoid smoking and keep alcohol within sensible limits, as both slow healing
• Look after your skin and any wounds, and keep them clean and dry
• Get support if you use drugs, through a local health service, to reduce the risk of further infection

Diet and exercise

Eat regular, balanced meals with plenty of vegetables, fruit, beans, and protein to help your body heal. Drink enough water. Gentle movement is encouraged once your team says it is safe, starting with short walks and simple exercises from your physiotherapist. Avoid heavy lifting, twisting, or contact sports until you are told it is safe. Build up a little at a time rather than pushing through pain.

Mental health and emotional wellbeing

It is very normal to feel frightened, frustrated, or low after an infection like this, especially if it came on suddenly or you spent time in hospital. You may worry about whether you will get back to normal. These feelings usually ease as you recover, but they can be heavy at times. Talk to your care team about how you are feeling, and ask about counselling or psychological support if it would help. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line straight away.

Prevention

It cannot always be prevented, but you can lower your risk. Treat infections early rather than waiting, keep skin wounds clean and covered, keep long-term conditions like diabetes well managed, and follow your care team's instructions after any spinal procedure. If you have a weakened immune system, tell your doctor about fever or new back pain promptly.

Vaccines

There is no vaccine that prevents an epidural abscess. Keeping up with routine vaccinations, such as those recommended for your age and health, helps protect you from some infections that could spread.

Screening programmes

There is no routine screening test for this condition. The best approach is knowing the warning signs and getting checked quickly if they appear.

Complications

If left untreated

• Pressure on the spinal cord that can cause lasting weakness or paralysis
• Permanent numbness or ongoing nerve pain
• Long-term problems controlling the bladder or bowel
• The infection spreading into the blood, which can make you very unwell
• Infection spreading to the bones of the spine or to the coverings of the brain

Long-term outlook

Most people recover well when an epidural abscess is found and treated quickly. Many need a period of antibiotics and physiotherapy, and the speed of recovery varies from person to person. Some people have lasting nerve symptoms, but recovery keeps improving for many months after treatment. Doing your follow-up and rehabilitation gives you the best chance of a good outcome.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.