What is the role of CSF analysis in the diagnosis of spinal epidural abscess?

Updated: Jul 12, 2018
  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Lumbar puncture (LP) is relatively contraindicated if spinal epidural abscess is suspected. However, LP may be essential to exclude meningitis from the differential diagnosis. Lumbar puncture runs the risk of introducing purulent material into the subarachnoid space. Some advocate slowly advancing the needle with gentle syringe aspiration if spinal epidural abscess is suspected; if purulent material is encountered, it should be aspirated gently to obtain laboratory specimens, and the needle should not be advanced further.

  • Cerebrospinal fluid (CSF) may show inflammatory cells, often a mixture of polymorphonuclear and mononuclear cells. Cell counts usually are increased, ranging from 10-1000 leukocytes/µL.

  • CSF protein usually is elevated above 100 mg/dL but may be higher, particularly if spinal block is present.

  • CSF glucose is usually normal; depression may indicate coexisting meningitis.

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