Hematogenous seeding from systemic bacteremia, as w/endocarditis
Or direct extension from adjacent osteomyelitis/discitis
Instrumentation/surgery
Bacterial: Staph > 60%; then e coli
TB and fungal unusual, unless immunocompromised
Risk Factors
Etoh
Ivdu
Other
Compromise from dm
Symptoms
Fever
Progressive acute/subacute pain
Site of neuro compromise based on location of abscess: cervical involvement can affect upper and lower extremities, bowel, bladder; lumbar involvement affects lower extremities, bowel, bladder
Sensory symptoms include numbness or neuropathic pain
Spectrum of extremity motor impairment: from weakness to paralysis
Bowel and/or bladder incontinence can occur (or spared)
Physical Exam Findings
Fever (sometimes)
May have focal pain of vertebrae on palpation at level of infection
Neuro findings varied based on level of abscess
Sensory symptoms include numbness (upper and/or lower extremities) based on level
Motor impairment (upper and/or lower extremities), with weakness to paralysis based on level of involvement and extent compression