(A) Sagittal and (B) axial T2WI MR images of the same patient in the initial stages of infection. Inhomogeneous increased signal is seen with the L5 and S1 vertebrae. The posterior halves of the endplates are ill-defined or obscure.

The paraspinal structures should be carefully reviewed as abscesses can form within the soft tissues. These may be isointense to muscle on T1-weighted images and hyperintense on T2-weighted images. Paraspinal abscesses may be best visualized in postcontrast T1-weighted images with fat suppression. Soft tissue abscesses will enhance mostly peripherally as the necrotic core remains hypointense (Figures 6-5 and 6-6).


In order to obtain a successful outcome early identification of the offending agent should be obtained. Early intravenous administration of antibiotics will lessen the incidence of epidural abscess formation, instability, and neurological deficits. Nutritional supplementation is of high importance as spinal infections frequently occur in patients with premorbid nutritional deficits, and the infection itself is a highly catabolic condition. The intravenous drugs should be administered for a period of at least 4-6 weeks and followed by orally administered antibiotics. C-reactive protein is more sensitive than sedimentation rate and should be frequently obtained to monitor response to treatment.

Epidural Abscess Formation

When the infective process is allowed to continue it may spread posteriorly into the spinal canal and compress the dural sac and/or the neural elements. Epidural collection of pus may quickly organize as an abscess within the spinal canal and lead to severe neurological deficits in about 30% of patients.

Epidural abscess (EA) is more common in the sixth and seventh decades, especially in immunocompromised, diabetic, and septicemic

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