Epidural Abscess of the Central Nervous System

This increase is likely due to a rising number of patients with risk factors for SEA including intravenous drug use (IVDU), diabetes mellitus, advanced age, renal failure, and compromised immunity as well as degenerative spinal column disease and the growing use of therapeutic spinal interventions including instrumentation, injections, catheter placement and anesthetic procedures.7,8 The ongoing opioid epidemic in the United States has had a particular impact on the increased incidence of SEA given the risks of endovascular infection and metastatic seeding associated with intravenous drug use.9 The clinical utility of associated risk factors in the diagnosis of SEA in unclear, however, given their apparent absence in 20-50% of patients.10 Detection of SEA with the wide-spread availability of sensitive imaging modalities such as magnetic resonance imaging (MRI) has also improved diagnostic accuracy in recent decades.8