Sagittal T2WI MRI showing an elongated mass dorsal to the spinal cord. The mass is hyperintense to the cord and represents epidu-ritis / an epidural abscess.

patients, and following spinal procedures and surgery. Most epidural abscesses occur in the low thoracic or lumbar regions. Cervical abscesses are less common but have a poorer outcome.

Clinical Presentation

Patients present with subacute to acute axial pain. At times, the complaints may be similar to those seen in patients with herniated discs. The patients may be febrile and have a high sedimentation rate and leukocytosis. In some patients radicular symptoms or sudden, progressive neurological deterioration may be the first clue to the presence of an epidural abscess. Within a short period of time the patient develops paralysis with loss of bladder and bowel control. In these cases an emergency MRI with contrast should be obtained.

Imaging Studies

The MRI will show a collection of substance that is hypointense to the spinal cord on T1-weighted images and hyperintense to the cord on T2-weighted images.

Following contrast administration the periphery of the collection will enhance, whereas the core of the abscess will not enhance (Figure 6-7). Frequently, the neural elements also enhance following contrast administration.


The abscess should be surgically drained under coverage of broad-spectrum antibiotics. Once the offending agent has been identified, a more specific antibiotic can be administered for at least eight more weeks. Consultation with infectious diseases specialists is of paramount importance in order to achieve a positive outcome.

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