Note on LP in spinal epidural abcess

Lumbar puncture (LP) is relatively contraindicated in spinal epidural abscess. MRI is the modality of choice for diagnosis. If LP is required to rule out meningitis, extreme caution should be exercise, as lumbar puncture may introduce purulent material into the subarachnoid space.

Needle should be slowly advanced with gentle syringe aspiration if spinal epidural abscess is suspected. If purulent liquid is encountered, it should be aspirated very gently to obtain culture, and the needle should not be advanced further.