Finding the needle in the haystack

Excerpt

Spinal epidural abscess (SEA) contains some of the greatest challenges and fears of emergency medicine within a single condition. SEA is a rare and potentially debilitating disease, which can be difficult to diagnose, with most individuals having several ED visits prior to diagnosis. The presenting complaint in SEA, low back pain, is a common presenting complaint, representing the fourth most frequent reason for adult emergency department (ED) visits [1]. The differential diagnosis of back pain is vast and varied, with SEA being only one among myriad pathologies responsible for back pain [2]. Our medical school training mantras fall short with the so-called “classic triad” [3] of SEA being found only in 10–15% of cases, and the definitive test, MRI with gadolinium, is expensive, time-consuming, and not always available. Delays in diagnosis may subsequently lead to significant morbidity with neurological deficits. In essence, SEA is analogous to the needle hidden in the haystack, which, if not recognized, has the potential to result in devastating consequences. …