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Spinal Epidural Abscess Pitfalls
- The classic triad of back pain, fever, and neurologic deficits are found in < 15% of patients at the time of presentation
- Up to 75% will be afebrile
- Up to 67% will have a normal initial neurologic exam
- < 40% have a WBC greater than 12,000 cells/mm3
- < 33% will have an abnormality on plain film in the first 7-10 days
Take Home Point: In the patient with risk factors for spinal epidural abscess (IVDU, DM, indwelling catheters, etc) do not exclude the diagnosis based upon the absence of a fever, a normal WBC count, and a normal neurologic exam.