UMEM Educational Pearls

Category: Orthopedics

Title: Laboratory testing for Spinal Epidural Abscess

Keywords: Spine infection, back pain (PubMed Search)

Posted: 3/16/2019 by Brian Corwell, MD
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Laboratory testing for Spinal Epidural Abscess

CBC

The CBC is poorly sensitive/specific

The WBC count may be nml or elevated

Left shift and bandemia may or may not be present

ESR and CRP

Sensitive but not specific

Elevated in >80% with vertebral osteomyelitis.

ESR
- ESR was elevated in 94-100% of patients with SEA vs. only 33% of non-SEA patients
CRP
- Less useful for acute diagnosis since CRP levels rise faster and return to baseline faster than ESR
  - Elevated CRP seen in 87% of patients with SEA as well as in 50% of patients with spine pain not due to a SEA
- Better used as a marker of response to treatment.

Reihsaus E, et al. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000.