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Case Reports
. 2023 Apr 1;17(1):116.
doi: 10.1186/s13256-023-03872-7.

Spontaneous lumbar intraspinal subdural abscess: a case report

Oscar James MacCormac  1   2 , Nabih Berjaoui #  3 , Sean Mizzi  4 , Difei Wang #  4 , Sabina Patel #  4 , Qusai Al Banna #  4 , Cristina Bleil #  4
Affiliations
Case Reports

Spontaneous lumbar intraspinal subdural abscess: a case report

Oscar James MacCormac et al. J Med Case Rep. .

Abstract

Background: Subdural spinous abscess is a rare pathology that carries significant morbidity if not diagnosed and treated early; of the cases reported in the literature, very few are genuinely spontaneous in nature.

Case presentation: Here we demonstrate the case of an otherwise entirely fit and well 56-year-old White, British female presenting with low back pain, bilateral sciatica and sensate urinary retention; lumbar subdural spinous abscess was diagnosed on urgent magnetic resonance imaging and the patient was successfully managed with surgical evacuation and prolonged antibiotic therapy. The patient made a full neurological recovery and was followed-up in the outpatient setting 12 weeks following her initial surgery; she was pain free with normal inflammatory markers and a normal neurological examination. There have been no further consultations and a telephone call at 20 weeks confirmed that she remains well.

Conclusions: This is the second case reported in the literature of a genuinely spontaneous subdural spinous abscess, which was successfully managed with surgical evacuation following prompt diagnosis. This highlights the need to ensure infective pathologies are kept at the back of one's mind even in the most unlikely circumstances, and that excellent outcomes can be achieved with early surgical intervention.

Keywords: Abscess; Case report; Empyema; Infection; Subdural.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Preoperative unenhanced sagittal T1-weighted MRI of the lumbar–sacral spine. B Contrast-enhanced sagittal T1-weighted MRI of the lumbar–sacral spine demonstrating enhancing collection (*)
Fig. 2
Fig. 2
A Thickened, inflamed dura mater B Intradural pus following durotomy C Hyperemic nerve root (*), D Organized, adherent pus not removed (**)
Fig. 3
Fig. 3
A Postoperative contrast-enhanced sagittal T1-weighted MRI of the lumbar-sacral spine B Postoperative contrast-enhanced axial T1-weighted MRI at the L4/5 level demonstrating a small residual enhancing collection (*) C Postoperative midline sagittal T2-weighted MRI of the lumbar-sacral spine demonstrating marked reduction in size of the preoperative collection D Postoperative axial T2-weighted MRI of the L4/5 level demonstrating marked reduction in size of the preoperative collection as well as small residual
See this image and copyright information in PMC

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