Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review

Abstract

We report a case of a spinal epidural abscess (SEA) in a patient without significant risk factors. The patient was treated in an outpatient setting for one week for worsening back pain and subsequently admitted to the hospital for the treatment of sepsis and suspected SEA. An MRI obtained on admission showed an epidural abscess extending from the lower cervical to the upper lumbar region and accompanying paraspinal cervical and psoas abscesses. The patient was successfully treated with antibiotics based on the sensitivity of the surgical cultures received from a needle aspiration of the abscess. SEA has a low incidence; however, the number of cases is consistently rising over the last two decades. The outcome of SEA treatment is related to the duration of the process prior to intuition of the treatment. Patients with no neurological symptoms, or with symptoms lasting less than 36 h, have the best recovery rate. As the typical symptoms of SEA are seen in only 13% of cases, physicians should have a low threshold to order MRI in patients with back pain that is new or changed from the baseline. With the help of CT-guided aspiration for culture analysis, patients can be successfully treated conservatively using antibiotics in cases where neurological signs are absent.

Figure 1

(a) Limited T1 postcontrast whole spine image showing enhancing posterior epidural collection (black arrows) from the level of C3 (not seen in the image) till L1. (b) Sagittal T1 postcontrast views at the cervical level, showing enhancing abscess around the right sternocleidomastoid muscle (black circle). (c) Axial T1 postcontrast images at lumbar levels showing enhancement of the left paraspinal muscles (black arrow) and additional abscess within the left psoas muscle (white arrow).