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
- Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006 Nov 09;355(19):2012-20.
- 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.
- 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.
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