Our experience in the diagnosis of spinal epidural abscess with the use of new diagnostic methods--computed tomography and magnetic resonance imaging

Abstract

A 69-year-old woman, a diabetic, presented to emergency unit for severe back pain that occurred three weeks of her having sustained a fall and blow in the back. Upon admission, she developed elevated body temperature, urinary retention and severe paraparesis of lower extremities. Laboratory testing showed increased levels of erythrocyte sedimentation rate (93 mm/h), leukocyte count (18.3 x 10(3)/ mL), C-reactive protein (246.5 mg/L) and liver enzymes, and abundant bacteria in urine sediment. Penicillin-resistant Staphylococcus aureus was isolated in blood culture. Antibiotic therapy according to the antibiotic sensitivity report was introduced. Magnetic resonance of thoracic spine revealed epidural liquid collection compressing the spinal medulla from Th2 to Th7. The patient was transferred to neurosurgery for posterior laminectomy and decompression, along with antibiotic therapy. Microbiology confirmed Staphylococcus aureus in the intraoperative tissue specimen. The patient was discharged from the hospital with mild paraparesis and continuing antibiotic therapy recommended.