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Case Reports
. 2017 Aug 1:8:167.
doi: 10.4103/sni.sni_171_17. eCollection 2017.

Chronic thoracolumbar subdural empyema: Case report and surgical management

Azam Basheer  1 , Mohamed Macki  1 , Morenikeji Buraimoh  2 , Asim Mahmood  1
Affiliations
Case Reports

Chronic thoracolumbar subdural empyema: Case report and surgical management

Azam Basheer et al. Surg Neurol Int. .

Abstract

Background: Spinal cord abscesses and spinal subdural empyemas are rare and difficult to treat.

Case description: A 35-year-old male presented to an outside institution with 2 months of progressive low back pain, weakness, and bowel incontinence; he was diagnosed with an L4 epidural abscess that was poorly managed. When the patient presented to our institution, magnetic resonance imaging (MRI) revealed a well-organized chronic subdural abscess at the thoracolumbar junction. Following resection, his back pain resolved but he was left with a residual paraparesis.

Conclusion: Subdural abscesses are rare and should be considered among the differential diagnoses for intraspinal mass lesions. Treatment should include prompt surgical exploration and decompression combined with appropriate prolonged antibiotic treatment.

Keywords: Chronic spinal subdural abscess; epidural abscess; spinal subdural abscess; spinal subdural empyema.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) T2 sagittal MRI: extensive loculated fluid collections compressing the spinal cord ventrally at T12-L2 and dorsally at T8-T12 level. Note T2 cord signal change within the distal thoracic cord/conus at T11-T12. (b) T1 sagittal MRI without contrast: anterior displacement of the cord from T9-T12 level. (c) T1 Sagittal MRI with contrast: distinct enhancement of the fluid collections at T8-T12, T12-L2 and leptomeninges/nerve roots in the cauda equina
Figure 2
Figure 2
(a) T2 sagittal MRI: high signal fluid collection compressing/displacing the conus posteriorly. Note the irregularly thickened/clumped together nerve roots. (b) T2 sagittal MRI: irregularly thickened/clumped together nerve roots of the cauda equina
Figure 3
Figure 3
Intraoperative images. (a) Tense, thickened dura without any epidural abscess. (b) The dural opening at L2 showed nerve root clumping with very little cerebrospinal fluid egress/phlegmon. (c) Second dural opening at T10 showed purulent discharge. (d) Intradural spinal cord thickening/adhesions
See this image and copyright information in PMC

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