Back Pain and Spinal Epidural Abscess-Back Pain and Spinal Epidural Abscess

Video Transcription

Video Summary

Tiffany Andrews, a nurse practitioner, discusses the evaluation and management of non-traumatic back pain in emergency medicine, emphasizing the importance of identifying rare but serious causes like spinal epidural abscess (SEA). Most acute back pain is mechanical and self-limiting, but missing critical diagnoses can lead to severe disability or death. Andrews highlights the need for thorough history-taking focused on risk factors (e.g., infection, cancer, immunosuppression), a detailed neurologic exam assessing motor, sensory, reflexes, and rectal tone, and appropriate use of labs and imaging. Red flags such as fever, IV drug use, unintentional weight loss, or bowel/bladder dysfunction should prompt further evaluation including ESR testing and MRI. Imaging is generally avoided unless conservative treatment fails or serious pathology is suspected. She presents patient cases illustrating that initial visits may have nonspecific symptoms, leading to delayed diagnosis of spinal infections. Treatment of SEA involves emergent surgical decompression plus tailored antibiotics, with close follow-up for neurologic changes. The talk underscores that vertebral infections are rare but must be considered in recurrent or worsening back pain, especially with risk factors. Early recognition, comprehensive assessment, and timely imaging improve outcomes and reduce complications. Andrews advocates for a systematic approach to back pain to avoid cognitive errors and ensure appropriate care.

Keywords

non-traumatic back pain

spinal epidural abscess

emergency medicine

neurologic examination

red flags

MRI imaging

antibiotic treatment

surgical decompression