Associates' Presentations
| Intro | Prev | Next | Last |
Spinal Epidural Abscess
O. Zubic, M.D., M. Mian, M.D., Sinai Samaritan Medical Center, Milwaukee, WI
A 44-year-old, white male presented with fever, low back pain, lower extremity weakness and difficulty in urination. He had been seen in the emergency department one-month prior with back pain. During the ensuing two weeks his pain intensified and was followed by weakness and bladder dysfunction. He had previously been in good health.
On admission he was noted to have a fever of 102.2F, loss of proprioception, decreased sensation and motor weakness in the lower extremities. Laboratory data revealed a WBC of 15.6 K/UL and ESR of 112 mm/hr. The blood cultures were positive for coagulase positive cocci. MRI of the thoracic spine demonstrated an epidural abscess with destruction of the T-11 - T-12 vertebral bodies and cord compression. Administration of broad-spectrum antibiotic agents was begun and adjusted when cultures identified Staph. aureus. Emergent spinal decompression was performed with cultures confirming Staph. aureus infection. Spinal fusion was also done and as soon as the patient's condition was stable, physical therapy was begun. On three-month follow-ups he regained limited ambulating ability.
Discussion: A spinal epidural abscess is an uncommon condition with an estimated incidence of 0.2-2.0/10000 hospital admissions. This serious infection results from direct extension of a local process or hematogenous spread from an antecedent or ongoing distant focus of infection. The most common organism cultured is Staph.aureus. The neurologic symptoms result from mechanical cord compression by the abscess mass. The thoracic spine is the site of the abscess in 50% to 80% of patients. The findings of back pain, tenderness, and fever should suggest the diagnosis, and the appearance of weakness and loss of sensation below the area of pain should be considered as the strongest possible clinical confirmation. In cases in which this constellation of findings occurs, rapid evaluation and immediate surgical decompression and drainage offers the patient a possible successful functional recovery. The extent and location of an abscess are best visualized using MRI. Multi planar imaging and visualization of the soft tissues including the spinal cord, para spinal musculature, and the disc confer a distinct advantage of MRI over CT and Myelography. Mortality associated with a spinal epidural abscess has ranged from 6.9%-23% in studies conducted during the past two decades. It has been well documented that the degree of recovery is closely related to early diagnosis and intervention and to the extent of a neurological deficit at the time of diagnosis.
| Intro | Prev | Next | Last |
What's New
Contact Information
Sharon Haase, MD, FACP
Chapter Governor
Kelly Lang
Chapter Support Staff
Ph: 414-755-6280
E-mail: lang@svinicki.com