Spinal epidural abscess following blunt pelvic trauma

Abstract

IntroductionSpinal epidural abscess is an uncommon disease, with a reported incidence of 0.2-1.96 per 10,000 hospital admissions [1]. As the presenting symptoms are often non-specific, a high level of suspicion is needed to initiate the appropriate diagnostics and provide prompt treatment. A recent review of the literature reports a suspected diagnosis of spinal epidural abscess in only 40% of cases [1]. Delayed diagnosis and treatment may, however, result in unexpected rapid neurological deterioration, even in patients without prior neurological deficit [1][2][3].We report an unusual case of blunt pelvic trauma with involvement of the sacroiliac joint and delayed diagnosis of a complicating epidural abscess of the lumbosacral spinal canal in a young man with a coexisting urinary tract infection. Case reportA 17-year-old adolescent fell from a height of approximately 1.5 m out of a tree onto his left side and rear pelvic region. Besides pain while walking on the left leg, no serious injury was noted. There was no loss of consciousness and there was no open injury. Twenty-four hours after the accident, pain increased in the lower back and radiated to the dorsal aspect of the left thigh. Three days after the accident, the patient was admitted to the orthopaedic department of another hospital because of persistent symptoms and elevated temperature of 40°C. On admission, the patient complained of the above-mentioned symptoms. The patient was alert and oriented. No motor or sensory deficit was noted on examination. Plain film radiographs of the spine showed a non-traumatic, Abstract A 17-year-old patient with pre-existing grade II spondylolisthesis of L5/S1 sustained a partial disruption of the left sacroiliac joint with haematoma of the iliac muscle after a fall. The haematoma probably led to occlusion of the left ureter, resulting in a urinary tract infection. After initial conservative treatment the patient developed fever and radicular pain of the left leg. Magnetic resonance imaging (MRI) revealed a left-sided epidural abscess at L5/S1, which had probably spread from the infected iliac haematoma along the injured sacroiliac joint. Prompt surgical drainage and antibiotic coverage with cefuroxime and flucloxacillin led to rapid clinical improvement. Staphylococcus aureus was identified as the pathogen. At follow-up 6 months postoperatively all symptoms had resolved, while MRI still revealed residual osseous oedema of the sacroiliac joint. The haematoma of the iliac muscle resolved without surgical intervention.

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