Spinal Epidural Abscess: Diagnostic Error and Risk Reduction

In the world of medicine, there are some diagnoses with presentations so stereotypical that it can be safely said, “If you’ve seen one, you’ve seen them all.” Such is not the case with spinal epidural abscess (SEA). In its early stages, the diagnosis of SEA often eludes even the most astute clinician. The incidence of SEA has reportedly doubled in the past two decades. The reasons given for this increase include an aging population, increased use of spinal procedures and vascular access, and the spread of IV drug use. SEA is a high-risk diagnosis for all practitioners, particularly in the Emergency Department, primary care office, and other settings that provide acute or episodic care. Medical errors may lead to profound disability or death, and lawsuits in this area are often exceptionally costly. Where potential spinal injury is possible, more extensive knowledge of SEA and awareness of key risk and documentation issues can significantly improve patient care and reduce the potential for litigation.

In this activity, we provide an overview of SEA (e.g., definition, location, pathophysiologic mechanisms responsible for formation, risk factors, laboratory evaluation and imaging, treatment, etc.) and examine the common reasons that practitioners delay or miss the diagnosis. We present and discuss two cases to highlight key risk and documentation issues. We also review the concept of heuristics and biases, or cognitive dispositions to respond (CDRs), and highlight cognitive errors in the two cases. After completing this activity, practitioners should be able to: determine when a patient encounter may involve heuristics and biases, or CDRs, in order to improve clinical decision-making and reduce the incidence of the failure to diagnose SEA; identify the signs and symptoms associated with the presence of SEA in patients presenting with back or neck pain; and evaluate patients presenting with back or neck pain, keeping in mind the rising incidence of SEA related to the increased incidence of community-acquired MRSA (CA-MRSA) in order to establish a comprehensive differential diagnosis and avoid the failure to diagnose SEA.

Credit & MOC Details

Credit information is provided by the course provider. We recommend confirming credit eligibility with the provider or your licensing board before starting the activity.

Target Specialties

Case-based learning
Credit · Up to 2 credits
Fee · varies

Released

Sep 23, 2025
Last day to claim credit

Sep 23, 2028 2 years left

Spinal Epidural Abscess: Diagnostic Error and Risk Reduction

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