Spinal Epidural Abscess in Adults

Abcesso epidural pós-traumático

“…AS patients are at high risk of experiencing spinal fractures with special characteristics, such as shearing, that may remain unperceived in over one third of the cases (9) . Trauma and immunodepression (in this case, secondary to prolonged AS treatment) are factors predisposing the development of epidural abscess (3,4,6) . Its association to closed trauma is seen in up to 15% of the cases (10) , but a primary infection source usually exists and can be identified.…”

“…HSS increases in a variable fashion, and Reihsaus et al have identified a rate of 6% of cases with normal HSS in their series of 117 patients with epidural abscess (5) . As for leukocytosis, it is present in 60-70% of the cases (6) , and, on the study by Soehle and Wallenfang (4) it could be correlated to the prognosis. Leukocyte counting was significantly higher in the group of patients showing poor evolution, both at admission and over the treatment period.…”

“…The requested NMR scan could identify the epidural mass, but was unable to distinguish hematoma from abscess (8,10) (Figure 1). Concerning site, thoracic spine seems to be associated to a worse prognosis of neurological recovery, even after surgical decompression procedure, when compared to cervical and lumbar spine (2,3,6,12) . In this case, emergency decompression within less than 12 hours after the onset of neurological symptoms may explain the complete recovery of the patient's motor function.…”

“…The incidence of epidural abscess is 0.2 to 1.2 cases for each 10,000 hospitalizations, this number being higher in reference centers (5) . In the last decade, there was a sudden raise on the number of cases, not only in immunodepressed and drug-addicted patients, but because of the increased number of diagnostic and therapeutic percutaneous procedures, and of the improved sensitivity of diagnostic studies, which frequently were unable to identify an epidural abscess (6) . Despite of affecting people of all age groups, a higher number of patients in the sixth or seventh decade of life are affected, as well as a higher number of men (2:1) (7) .…”

“…In drug addicted individuals, a higher incidence of Gram-negative bacilli and pseudomonas is seen. In up to 40% of the cases, the infectious microorganism cannot be identified (6,8) . This study intends to present an epidural abscess case secondary to spine fracture, in a patient having ankylosing spondylitis.…”