Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal Epidural Abscess

Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal Epidural Abscess

Edward J. Durant et al.
Western Journal of Emergency Medicine, February 24, 2025

🩺 Clinical Takeaway:

• Classic SEA presentations are uncommon; relying on the triad may miss diagnoses.
  
  

• Missed opportunities are frequent—71% had a potentially related prior visit.
  
  

• Consider SEA in patients with persistent/recurrent back or neck pain, especially with:
  
  

• Diabetes
  
  

• Recent infection
  
  

• Repeated visits with unclear etiology
  
  

🔑 Early MRI and neurosurgical consultation should be considered even when classic features are absent if suspicion is high.

🧪 Methods:

• Retrospective cohort study across an integrated healthcare system.
  
  

• 457 adult patients with MRI-confirmed SEA (2016–2019).
  
  

• Chart reviews focused on:
  
  

• Visits in the 30 days prior to diagnosis
  
  

• SEA-related symptoms
  
  

• Comorbidities/risk factors
  
  

📊 Key Findings:

• 71% had ≥1 ambulatory or ED visit in the 30 days before SEA diagnosis.
  
  

• Classic triad (back pain, fever, neurologic deficits) was present in only 10%.
  
  

• Back/neck pain or tenderness occurred in >90%.
  
  

• Most common SEA location: Lumbar spine (51%).
  
  

• Common risk factors:
  
  

• Diabetes mellitus
  
  

• Recent infection (within 90 days)
  
  

• Rare risk factors:
  
  

• Injection drug use
  
  

• Chronic steroid use
  
  

• HIV
  
  

• Solid organ transplant

Durant, E.J., Copos, S., Folck, B.F., Anderson, M., Ghiya, M.S., Hofmann, E.R., Vuong, P., Shan, J. and Kene, M., 2025. Diagnostic Delays Are Common, and Classic Presentations Are Rare in Spinal Epidural Abscess. Western Journal of Emergency Medicine, 26(3), p.692.