TITLE:
Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects
AUTHORS:
Evan Cohen, Melissa Zahl, Lindsay Hock, Michael Olshansky
KEYWORDS:
Spinal Epidural Abscess, Holospinal Abscess, Cauda Equina, Spinal Compression
JOURNAL NAME:
Surgical Science,
Vol.14 No.8,
August
23,
2023
ABSTRACT: Spinal epidural abscesses (SEA) are considerably rare and tend to present
over two to five vertebral segments. Occasionally, there will be two or more
noncontiguous areas of pyogenic collections [1]. Minimal cases have been reported to span the entire vertebral column; a
meta-analysis estimates that 1% of all SEA are holospinal [2]. The
triad of presenting symptoms includes fever, back pain (often midline), and
neurologic defects [1] [2] [3]. Early detection is identified as a critical aspect of improved
outcomes. Cases that do not present in this manner or with other masking
symptoms can lead to delayed diagnosis, thus delaying treatment. In the event
of cord compression, the occurrence of neurologic defects increases. Time from
the onset of clinical manifestations to the operating room is crucial in
reversing symptoms [2]. This
article seeks to review a case of a 65-year-old male that presented to the
emergency department (ED) due to a falling second to weakness and thigh pain. On presentation, he was also noted to
have rhabdomyolysis causing acute kidney injury (AKI) with tubular necrosis.
The patient was admitted to the hospital with a complex history of progressive
leg weakness, pain in the lower back, incontinence, and elevated white blood
cell count. Days into the admission, a
magnetic resonance imaging (MRI) study was performed, which revealed
a continuous posterior SEA from C4 to S2 with anterior mass effect causing
spinal cord compression. Emergency neurosurgery was scheduled for laminectomies
in the cervical, thoracic and lumbar spine to drain the abscess. Evaluation of
this complex medical course, surgical approach to drainage of an incessant
spinal column abscess, and sustained neurologic defects will be discussed.