Spinal Epidural Abscess: When a Missed or Delayed Diagnosis Causes Permanent Harm

A spinal epidural abscess (often called “SEA”) is a dangerous spinal infection that can rapidly compress the spinal cord. When medical providers miss early warning signs – or delay ordering the right imaging and treatment – patients can suffer paralysis, permanent nerve damage, loss of bladder/bowel control, sepsis, or death.

If you or a loved one became significantly worse after an emergency room visit, urgent care visit, or hospital admission for severe back/neck pain and the diagnosis of spinal epidural abscess was delayed, Smith, Gildea & Schmidt, LLC can provide a confidential case review.

Contact us here or call (410) 821-0070.

What Is a Spinal Epidural Abscess (SEA)?

A spinal epidural abscess is a collection of infection in the epidural space – the area around the protective covering of the spinal cord. Even when the infection starts small, inflammation and pressure can build quickly, compressing the spinal cord and nerves. This is why SEA is often treated as a medical and surgical emergency.

Why SEA is so dangerous

• Time matters: neurological damage can become permanent if decompression and antibiotics are delayed.
• Symptoms can be misleading: patients may not have “classic” signs early on.
• It can look like routine back pain: leading to discharge without MRI or appropriate follow-up.

Common Symptoms and “Red Flags” Providers Should Not Ignore

SEA does not always present the same way in every patient. Some people have fever; some do not. Some have neurological symptoms early; others develop them later. But there are well-known warning signs that should trigger urgent evaluation.

Symptoms commonly reported

• Severe back or neck pain (often focal, worsening, and out of proportion to exam)
• Fever, chills, or feeling unwell (but fever may be absent)
• Weakness, numbness, tingling, or difficulty walking
• Saddle anesthesia (numbness in the groin/buttocks region)
• Bladder/bowel dysfunction (retention or incontinence)

Risk factors that increase suspicion

• Diabetes or immunosuppression
• Recent bloodstream infection, skin infection, or MRSA
• Recent spinal procedure, injection, surgery, epidural, or indwelling catheter
• IV drug use history
• Recent hospitalization or persistent unexplained elevated inflammatory markers

Key point: The “classic triad” of back pain, fever, and neurologic deficit is not consistently present, which is precisely why SEA requires careful clinical judgment and appropriate imaging when red flags appear.

How Spinal Epidural Abscess Should Be Diagnosed

When SEA is suspected, an MRI is widely recognized as the most appropriate diagnostic imaging study. In many cases, delays happen because providers rely on a CT (or no advanced imaging at all), discharge the patient, and the condition progresses until neurological injury becomes severe.

Common diagnostic steps

• Focused neurological exam and reassessment when symptoms evolve
• Inflammatory markers (often ESR/CRP), CBC, and blood cultures when clinically indicated
• Urgent MRI when clinical suspicion exists
• Early consultation with appropriate specialists (often neurosurgery and infectious disease)

Because SEA can spread and compress the spinal cord at multiple levels, clinicians may need to consider whether imaging should assess more than one spinal region depending on symptoms and exam findings.

Medical Errors That Can Lead to a Missed or Delayed SEA Diagnosis

Not every bad outcome is malpractice. But when providers fail to meet the accepted standard of care – and that failure causes injury – a medical malpractice claim may be appropriate.

Examples of potentially negligent errors

• Discharging a patient with severe back pain and red flags without appropriate workup or return precautions
• Failure to order an MRI despite symptoms/risk factors suggesting SEA
• Relying on CT alone when MRI is indicated
• Failure to act on abnormal labs (e.g., markedly elevated inflammatory markers) or positive blood cultures
• Delays in transfer to a facility with MRI or neurosurgical capability
• Delay in antibiotics or delay in surgical decompression when indicated
• Communication breakdowns during handoffs (ER-to-hospitalist, hospitalist-to-specialist, etc.)

In many SEA cases, the lawsuit focus becomes: when should SEA have been suspected, whether appropriate imaging was ordered, and whether delays allowed the abscess to progress to irreversible neurologic injury.

Injuries and Damages in Spinal Epidural Abscess Malpractice Cases

A delayed SEA diagnosis can change a person’s life in a matter of hours or days. Damages often extend far beyond the initial hospitalization.

Common life-altering outcomes

• Paraplegia or quadriplegia
• Chronic neuropathic pain
• Neurogenic bladder/bowel and sexual dysfunction
• Long-term rehabilitation, mobility devices, home modifications
• Lost income and diminished earning capacity
• Need for long-term care or attendant care
• Wrongful death damages for surviving family members (in appropriate cases)

How SEA Malpractice Claims Work in Maryland

Maryland has specific procedural requirements for medical malpractice claims, and deadlines can be strict. In general, Maryland law provides that a claim for injuries arising from the rendering of – or failure to render – professional services by a health care provider must be filed within the earlier of certain time limits.

Important deadlines

• In general, medical malpractice claims must be filed within the earlier of: five years from when the injury was committed or three years from when the injury was discovered.

Important: The statute of limitations analysis can be fact-specific, especially in delayed diagnosis cases. You should speak with an attorney as soon as possible to protect your rights.

Procedural requirements

Maryland law also includes pre-suit/early filing requirements in many malpractice cases, including filing through Maryland’s medical malpractice claims process and submitting required expert certification. These rules can affect whether a case can proceed.

How Smith, Gildea & Schmidt Investigates a Spinal Epidural Abscess Case

SEA cases often turn on timelines: what symptoms were reported, what was documented, what testing was ordered, and how quickly treatment occurred once SEA became a consideration.

Our typical investigation includes

• Obtaining complete medical records (EMS, ER, urgent care, inpatient, imaging, labs, consults)
• Building a clear timeline of symptoms, evaluations, and decision points
• Reviewing imaging orders and radiology reads
• Consulting appropriate medical experts on standard of care and causation
• Assessing damages and future care needs

We handle complex civil litigation throughout Maryland. For more about our practice, visit our Medical Malpractice page.

Talk to a Maryland Spinal Epidural Abscess Lawyer

If you suspect a missed or delayed diagnosis of spinal epidural abscess led to paralysis, neurologic injury, or death, you deserve answers.
Our team can review medical records, consult qualified experts, and help you understand whether the standard of care may have been violated.

Contact Smith, Gildea & Schmidt, LLC for a confidential case review:
Contact us online or call (410) 821-0070.

Frequently Asked Questions (FAQ)

Can a spinal epidural abscess be missed even if I didn’t have a fever?

Yes. Some patients do not present with the “classic triad.” Providers should consider the total clinical picture, including severe focal back pain, risk factors, and evolving neurologic symptoms.

What test should be ordered when SEA is suspected?

MRI is commonly recognized as the appropriate imaging study when SEA is suspected. Delays can occur when MRI is not ordered or is delayed.

What are common mistakes that lead to delayed SEA diagnosis?

Examples include discharging a patient with red flags, failing to order MRI, relying on CT alone, delayed transfer to a facility with MRI/neurosurgery, or delayed treatment once SEA is suspected.

How long do I have to file a medical malpractice claim in Maryland?

Deadlines can be strict and fact-specific. In general, Maryland malpractice claims must be filed within the earlier of five years from when the injury was committed or three years from when it was discovered. An attorney can evaluate your specific timeline.

What should I bring to a case review?

If available: discharge papers, a timeline of symptoms and visits, facility names, and any imaging/lab information. If you don’t have records, we can discuss how to obtain them.