Extensive Spinal Epidural Abscess Resulting in Complete Paraplegia Treated by Selective Laminectomies and Irrigation.

Abstract

BACKGROUND:

Spinal epidural abscess (SEA) is an uncommon clinical entity that is often subject to delayed diagnosis and suboptimal treatment. Untreated disease leads to compression of the spinal cord, resulting in devastating complications.

CASE PRESENTATION:

A 56-year-old man visited our hospital for progressive lower back and lower extremity pain of several days' duration. Significant pyrexia (39.5°C) and elevated C-reactive protein (89.2 mg/L) were detected during admission, but no positive neurological examination findings were observed. Magnetic resonance imaging revealed pyogenic discitis at L3-4. Despite the administration of directed antibiotic therapy, the patient's condition rapidly deteriorated, culminating in complete paraplegia secondary to an extensive SEA from L4 to C7. Emergency spinal decompression surgery was canceled due to his poor clinical condition and refusal of informed consent. After further deterioration, he consented to two-level selective laminectomies and irrigation.

CONCLUSIONS:

In contrast with prior case reports, this case illustrates the natural history of an extensive SEA during conservative and late surgical treatment. Early diagnosis and timely surgical decompression are of great importance for extensive SEA.

• Authors: Tongshuai Xu, Yukun Du, Jianwei Guo, Jianyi Li, Cheng Shao, Changfang Shi, Xianfeng Ren, Yongming Xi
• Journal: Orthopaedic surgery (Orthop Surg) Vol. 14 Issue 9 Pg. 2380-2385 (Sep 2022) ISSN: 1757-7861 [Electronic] Australia
• PMID: 35732468 (Publication Type: Case Reports)
• Copyright: © 2022 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.

Chemical References

• Anti-Bacterial Agents
• C-Reactive Protein

Topics

• Anti-Bacterial Agents (therapeutic use)
• C-Reactive Protein
• Epidural Abscess (complications, surgery)
• Humans
• Laminectomy (adverse effects)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Paraplegia (diagnosis, etiology, surgery)