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. 2015 Sep 17:9:47.
doi: 10.14444/2047. eCollection 2015.

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

Maire-Clare Killen  1 , Miguel Hernandez  1 , Andrew Berg  2 , Chandra Bhatia  1
Affiliations

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

Maire-Clare Killen et al. Int J Spine Surg. .

Abstract

Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised. Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature. Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality. Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities. We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery.

Keywords: Epidural; abscess; multi-regional; nonoperative.

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Figures

Fig. 1
Fig. 1
Initial lumbar MRI scan demonstrating extradural cystic collection extending to L1.
Fig. 2
Fig. 2
Additional T2-weighted images of the cervical and thoracic spine showing a widespread epidural collection.
Fig. 3
Fig. 3
After 4 weeks of antibiotics, repeat MRI showed improving findings, with a small persisting collection at T11.
Fig. 4
Fig. 4
Further MRI at 12 months from initial presentation, with complete resolution of radiological findings.
See this image and copyright information in PMC

References

    1. Fang WK, Chen SH, Huang DW, Huang KC. Post-traumatic osteomyelitis with spinal epidural abscess of cervical spine in a young man with no predisposing factor. J Chin Med Assoc. 2009;72:210–213. - PubMed
    1. Mackenzie AR, Laing RB, Smith CC, Kaar GF, Smith FW. Spinal epidural abscess: the importance of early diagnosis and treatment. J Neurol Neurosurg Psychiatry. 1998;65:209–212. - PMC - PubMed
    1. Manickam A, Marshman L, Korah I. Panregional (cervico-thoraco-lumbo-sacral) spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with nonoperative management. Interdisciplin neurosurg. 2014;1:69–72.
    1. Morgagni JB. The Seats and Causes of Diseases Investigated by Anatomy; in Five Books, Containing a Great Variety of Dissections, With Remarks. To Which Are Added Very Accurate and Copious Indexes of the Principal Things and Names Therein Contained. In: Alexander B, editor. London: Johnson and Payne; 1769.
    1. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355:2012–2020. - PubMed

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