Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review

Abstract

We report a case of a spinal epidural abscess (SEA) in a patient without significant risk factors. The patient was treated in an outpatient setting for one week for worsening back pain and subsequently admitted to the hospital for the treatment of sepsis and suspected SEA. An MRI obtained on admission showed an epidural abscess extending from the lower cervical to the upper lumbar region and accompanying paraspinal cervical and psoas abscesses. The patient was successfully treated with antibiotics based on the sensitivity of the surgical cultures received from a needle aspiration of the abscess. SEA has a low incidence; however, the number of cases is consistently rising over the last two decades. The outcome of SEA treatment is related to the duration of the process prior to intuition of the treatment. Patients with no neurological symptoms, or with symptoms lasting less than 36 h, have the best recovery rate. As the typical symptoms of SEA are seen in only 13% of cases, physicians should have a low threshold to order MRI in patients with back pain that is new or changed from the baseline. With the help of CT-guided aspiration for culture analysis, patients can be successfully treated conservatively using antibiotics in cases where neurological signs are absent.

Pus in Spinal Needle: Diagnosis and Management of a Long-Segment Spinal Epidural Abscess

“…In a suspected patient with SEA, MRI with gadolinium is the gold-standard imaging [ 2 ]. Although CT with intravenous contrast is less sensitive, it is used as an alternative when the former is not available.…”

“…The antibiotic therapy in SEA is generally parenteral and protracted. Duration varies from 4 to 12 weeks [ 2 ]. Follow-up is a necessity as recurrences of SEA are not infrequent; however, provided the clinical and basic investigations of infection are normalized, serial radiological tests are usually not required [ 1 ].…”

“…[ 1 ] As the dura is tightly attached to vertebral bodies and ligaments anteriorly, epidural abscess tends to occur more in the posterior epidural space. The thoracic region being the longest of all three has the most reported cases of epidural abscesses [ 2 ]. Considering the cervical-sacral continuity of the epidural space, infection in a single space could spread to multiple levels, with an average of three spinal segments [ 3 ].…”

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

“…Regarding delayed diagnosis, clinicians need to have SEA high on the differential when the triad appears, regardless of what other symptoms may present, and act as a mask. Timely diagnosis may create an opportunity for medical management avoiding surgery, and prevent permanent neurologic defects [3] [10]. However, most cases will require surgical intervention [1].…”

Anterior transcorporeal full-endoscopic drainage of a long-span ventral cervical epidural abscess: A novel surgical technique

“…When patients present with sepsis, significant or progressive neurological deficits, instability, or failure of medical treatment, surgical intervention is indicated [4 , 9 , 10] . The goals of surgical treatment for cervical epidural abscess are infectious source eradication, adequate drainage of abscesses, debridement of necrotic tissue, spinal cord decompression, and stabilization in cases of instability [2 , 11 , 12 , 13] .…”