Although rare in children, spinal epidural abscess (SEA) is a rapidly progressive clinical entity that can lead to irreversible neurologic damage if untreated. The rarity and variability in presentation can lead to initial misdiagnosis. Diagnosis requires a high index of suspicion and is often delayed until neurologic deficits are present. This issue reviews key findings on the history and physical examination that are associated with SEA, provides guidance for the laboratory tests and imaging studies that are indicated once SEA is suspected, and discusses treatment options based on current evidence.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Auletta JJ, John CC. Spinal epidural abscesses in children: a 15-year experience and review of the literature. Clin Infect Dis. 2001;32(1):9-16. (Review of the literature; 8 patients) DOI: 10.1086/317527
2. * Hawkins M, Bolton M. Pediatric spinal epidural abscess: a 9-year institutional review and review of the literature. Pediatrics. 2013;132(6):e1680-e1685. (Retrospective review; 9 patients) DOI: 10.1542/peds.2012-3805
4. * Vergori A, Cerase A, Migliorini L, et al. Pediatric spinal epidural abscess in an immunocompetent host without risk factors: case report and review of the literature. IDCases. 2015;2(4):109-115. (Case report and review of the literature; 12 cases) DOI: 10.1016/j.idcr.2015.09.008
7. * Fotaki A, Anatoliotaki M, Tritou I, et al. Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood. Acta Paediatr. 2019;108(1):28-36. (Review) DOI: 10.1111/apa.14579
13. * Vallejo JG, Cain AN, Mason EO, et al. Staphylococcus aureus central nervous system infections in children. Pediatr Infect Dis J. 2017;36(10):947-951. (Prospective surveillance study; 68 patients) DOI: 10.1097/inf.0000000000001603
14. * Houston R, Gagliardo C, Vassallo S, et al. Spinal epidural abscess in children: case report and review of the literature. World Neurosurg. 2019;126:453-460. (Case report and literature review; 1 patient) DOI: 10.1016/j.wneu.2019.01.294
27. * Fucs PM, Meves R, Yamada HH. Spinal infections in children: a review. Int Orthop. 2012;36(2):387-395. (Review) DOI: 10.1007/s00264-011-1388-2
48. * Mohanty CB, Fieggen G, Deopujari CE. Pediatric spinal infections-a review of non-tuberculous infections. Childs Nerv Syst. 2018;34(10):1947-1956. (Review) DOI: 10.1007/s00381-018-3885-8
51. * Arko Lt, Quach E, Nguyen V, et al. Medical and surgical management of spinal epidural abscess: a systematic review. Neurosurg Focus. 2014;37(2):E4. (Systematic review; 12 articles, 1099 patients) DOI: 10.3171/2014.6.Focus14127
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Keywords: spinal epidural abscess, SEA, pediatric spine infection, stages of spinal epidural abscess
Bahareh Ravandi, MD; Christine S. Cho, MD, MPH, MEd
Winnie Whitaker, MD; Amy Z. Zhou, MD, PhD
June 2, 2022
July 1, 2025
Date of Original Release: June 1, 2022. Date of most recent review: May 1, 2022. Termination date: June 1, 2025.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME: Not applicable. For more information, please call Customer Service at 678-366-7933.
ACEP Accreditation: Pediatric Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAP Accreditation: This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 48 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics.
AOA Accreditation: Pediatric Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.
Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for emergency physicians.
Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
CME Objectives: Upon completion of this activity, you should be able to (1) develop a differential diagnosis that includes spinal epidural abscess (SEA) when a patient presents with concerning symptoms or for nonspecific complaints; (2) discuss the emergent nature of SEA and the importance of prompt diagnosis; (3) order testing and imaging to aid in diagnosis; and (4) initiate early empiric treatment when SEA is suspected, even without definitive diagnosis.
Discussion of Investigational Information: As part of the journal, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
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