Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

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 fall ing 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 admis sion, a magnetic resonance imaging (MRI) study was performed, which r evealed 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.