Investigations

The following investigations are indicated if a spinal abscess is suspected:

• plain X-ray films: (1)
  • acutely, may be normal, show soft tissue swelling or vertebral collapse
  • chronically, may show destruction of the intervertebral disc space and the vertebrae
• MRI - the definitive investigation for abscess localisation. MRI with gadolinium enhancement is the imaging of choice. It has a sensitivity of more than 90% and helps delineate the extension of the lesion, helps in management strategies, as well as differentiating from other possible conditions. (2)

Note - myelography is no longer indicated. (3)

Reference

1. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006 Nov 09;355(19):2012-20.
2. Shifrin A et al. Paraspinal Edema Is the Most Sensitive Feature of Lumbar Spinal Epidural Abscess on Unenhanced MRI. AJR Am J Roentgenol. 2017 Jul;209(1):176-181.
3. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000 Dec;23(4):175-204; discussion 205.