Spine II Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Question 2) A 55-year-old patient presents with 2 days of fevers, chills, and low back pain. MRI with contrast shows an L3-4 epidural abscess. The patient is hemodynamically stable and neurovascularly intact on exam. What’s the next best step?Select the Correct AnswerBlood CulturesCT ScanBiopsyLaminectomyAntibioticsCorrect Answer: Blood Cultures Explanation: If a patient with an epidural abscess is neurologically intact and hemodynamically stable (HDS), then blood cultures are the next best step to isolate the pathogen in the most minimally invasive way. MRI with contrast, which is already obtained, is the best study to evaluate for this pathology, so CT is not the next best step. If a patient is HDS, antibiotics should be held to isolate the pathogen to narrow antibiotics. Biopsy isn’t needed if blood cultures are positive – go with the least invasive option first. Surgery isn’t the next best step. Surgery necessary if neurologic deterioration, refractory to antibiotics, or spinal deformity/instability References: Source: Le HV, Tsai C, Lee SJ, Chien BY, Lipa SA, Qudsi RA, Suneja N, Dyer GSM. High-Yield Orthopaedics: OITE & ABOS Review for Orthopaedic Providers [Kindle]. Seattle, WA: Kindle Direct Publishing; 2019. Risk factors for failure of non-op management for patients with epidural abscesses. Kim SD, Melikian R, Ju KL, Zurakowski D, Wood KB, Bono CM, Harris MB. Independent predictors of failure of nonoperative management of spinal epidural abscesses. Spine J. 2014 Aug 1;14(8):1673-9. doi: 10.1016/j.spinee.2013.10.011. Epub 2013 Oct 30. PMID: 24373683 Wrong Answer: Please try again! Submit Post navigation Previous QuestionSpine INext QuestionHand I
