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Orthopaedics · Spine: epidural abscess
Sample itemAn intravenous drug user has back pain, fever, and new leg weakness. Which investigation is the best next step?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Urgent MRI of the whole spine with contrast
The classic triad of spinal epidural abscess is back pain, fever and neurological deficit. MRI with gadolinium is the investigation of choice and should be done urgently, along with blood cultures, and treatment is surgical decompression and antibiotics for Staphylococcus aureus.
Option by option
A. Plain radiographs and a review in 2 weeks
Plain films are insensitive and delaying risks permanent paralysis.
B. Lumbar puncture before imaging
Lumbar puncture through an abscess risks spreading infection.
C. Urgent MRI of the whole spine with contrast (correct)
Correct. Urgent MRI is the best investigation.
D. Bone scan after 1 week
A bone scan is slow and less specific.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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