The EM Educator Series: Sneaky Back Pain

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!


A 33-year-old male presents with fever and back pain. He has a history of intravenous drug use. His symptoms started 1 week ago with back pain, but he noted fever and chills starting yesterday. He is febrile in the ED and has tenderness over T12-L3. His neurologic exam is normal, and he denies any bladder or bowel symptoms or other focal deficits.



  • Regarding spinal epidural abscess (SEA), who is at risk, and how does it present?
  • What are the common bugs involved?
  • What is the ED evaluation, and what tests should you obtain?
  • Do labs play a role in the assessment? Who needs an emergent MRI?
  • When should antibiotics be used, and when should they be held?
  • If you use administer antibiotics, what ones in particular are recommended?


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