En la mayor parte de las series se ha observado un predominio en el sexo masculino Tang et al, Acute spinal epidural abscess without concurrent spondylodiscitis. Acta Orthop Scand ; 70 2 : Rev Neurol ; 30 8 :
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Cases and figures Epidemiology Spinal epidural abscess is an uncommon condition with an estimated incidence of per 10, hospital admissions. It has a peak incidence in the fifth-to-seventh decades of life with a male predominance, which might be due to predisposing conditions and risk factors that are more prevalent in older people 2.
Back pain and severe, circumscribed tenderness are by far the most frequent early findings 2. Paralysis may result via spinal compression from a mass-effect exerted by the abscess or secondary ischaemia to from septic thrombosis 8.
In contrast, when facet joint septic arthritis is the primary infection, collections tend to be posterior or posterolateral.
Plain radiograph Plain films have little role to play in investigating a patient with suspected spinal epidural abscess, as no direct visualisation of the collection is possible. They can, however, be useful in visualising established discitis- osteomyelitis , particularly when MRI and to a lesser extent CT are not available.
CT Despite excellent bony anatomical details, CT even with contrast can struggle to demonstrate smaller collections. Diffusion-weighted sequences are useful to confirm infection 8. There are two main patterns, with distinct imaging appearances 5: phlegmonous stage of infection results in homogeneous enhancement of the abnormal area which correlate to granulomatous-thickened tissue with embedded micro-abscess without a significant pus collection liquid abscess surrounded by inflammatory tissue which shows varying degree of peripheral enhancement with gadolinium The key to identifying liquid abscess, which is usually sufficient cause for surgical drainage, is the presence of a region of high T2 signal, with low T1 signal and without enhancement usually surrounded by a rim of enhancement.
CASO # 90 ABSCESO EPIDURAL ESPINAL