Spinal epidural abscess

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Abstract

INTRODUCTION: Spinal epidural abscess (SEA) is a rare but severe infectious disease, characterized by the accumulation of pus in the epidural space of the spine. This condition may cause spinal cord and spinal root compression, resulting in a persistent neurological deficit or even death in the event of a delayed or incorrect diagnosis. The prevalence of SEA has increased in the recent decade, which is attributed to increased life expectancy, extensive use of invasive procedures, and an increase in risk factors such as diabetes mellitus, obesity, and intravenous drug abuse. SEA is difficult to diagnose because of its non-specific symptoms. However, clinicians’ awareness and early use of magnetic resonance imaging (MRI) allow timely disease detection and therapy initiation.

CLINICAL CASE DESCRIPTION: Patient (55 years old), presented with complaints of weakness in all extremities and neck pain. The medical history started roughly 4 months ago, beginning with strep throat, after which the patient developed increasing weakness in the extremities. Based on the MRI and CT findings, the following diagnosis was made: SEA at the C4–C5 level, causing spinal cord compression. The following procedures were performed: C4 and C5 corporectomy, epidural abscess excision and drainage, and stabilization with a cervical plate and autograft. A significant improvement was observed in the postoperative period, with a notable decrease of neurological deficit at discharge.

CONCLUSION: This case report highlights the need to improve awareness of SEA among healthcare professionals for early diagnosis and treatment initiation, particularly in high-risk patients. Despite advances in treatment, mortality rates and the incidence of neurological complications remain high, necessitating further research to improve treatment strategies and outcomes in SAE patients.

About the authors

Anton G. Nazarenko

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: NazarenkoAG@cito.priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN-code: 1402-5186

MD, Dr. Sci. (Medicine), рrofessor

Russian Federation, Moscow

Alexander A. Kuleshov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: cito-spine@mail.ru
ORCID iD: 0000-0002-9526-8274
SPIN-code: 7052-0220

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

Sergey V. Yundin

MEDSI

Author for correspondence.
Email: yundin74@mail.ru
ORCID iD: 0000-0001-6382-5622
SPIN-code: 5728-7100

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Dmitri S. Izotkin

MEDSI

Email: dimitry.izotkin@gmail.com
ORCID iD: 0009-0001-4151-3430

MD

Russian Federation, Moscow

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2. Fig. 1. Location of epidural abscesses in the spinal canal: а — ventral, b — dorsal. Adapted from Tetsuka S., 2020 [45].

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3. Fig. 2. Spondylodiscitis at the C4-C5. Computer tomography (a, b) revealed destruction of the C4-C5 vertebral bodies. MRI images (c, d) showed spinal cord compression at the C4-C5 level.

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4. Fig. 3. Postoperative cervical MRI and radiographic imaging data (a, b) show that the C3-C6 cervical segment stabilized with an autograft and an anterior cervical plate, с — the spinal canal stenosis has been resolved, and there is no evidence of spinal cord compression.

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