Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient - A Case Report -

Abstract

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.

Emergency surgery for a patient with a thoracic spinal epidural abscess: a case report and literature review

“… 6 , 7 SEA lesions are more common in the thoracic and lumbar segments. 8 Men aged older than 60 years are more likely to have SEA, with a male to female ratio of 3:1. 9 , 10 SEA is divided into (1) the acute type in which all lesions are pus, (2) the subacute type with coexistence of pus and granulation tissue, and (3) the chronic type with mainly granulation tissue.…”

A Rare Multilevel Spinal Epidural Abscess With Streptococcus agalactiae in an Adult With Uncontrolled Diabetes: A Case Report

“…The location of the abscess also plays a crucial role in treatment considerations. Spinal epidural abscesses most frequently occur at the lumbar level (48%), followed by the thoracic (31%) and cervical (21%) levels [ 3 ]. The development of SEA can be attributed to hematogenous spreading, direct spread from adjacent structures, or direct inoculation from invasive procedures [ 3 ].…”

Transforaminal Endoscopic Drainage of Massive Anterior Epidural Abscess-Novel Technique

“…Adogwa et al in their study of 82 patients with spinal epidural abscess found that 70% were ventrally located and 30% dorsally located9. Hwang et al reported a case of long level ventrally located thoracic spinal epidural abscess, where multilevel laminectomy failed to achieve motor recovery 14) . Hence ventrally located abscesses are difficult to drain using standard techniques.…”