A rare presentation of spinal epidural abscess

Background: Therapeutic epidural spinal injections (ESIs) of steroids are one of the most common nonsurgical management modalities employed for alleviating pain due to chronic persistent lumbar spinal disease. However, it is well documented that they have significant risks and complications without any long-term efficacy. ESI may result in epidural empyema which may be difficult to diagnose with delays resulting in significant permanent neurological sequelae. Case Description: A 45-year-old female presented with a lumbar spinal epidural empyema after receiving ESI for low back and right leg pain due to a lumbar disc herniation. Laboratory studies showed elevations of multiple inflammatory markers, and the MR documented a significant lumbar epidural empyema contributing to significant thecal sac compression. Clinically, the patient had an acute cauda equina syndrome warranting emergency surgery consisting of a laminectomy for debridement/decompression followed by long-term antibiotic treatment. Conclusion: Epidural empyema is a major potential complication of lumbar ESI. Multiple markedly elevated inflammatory markers (WBC, ESR, CRP, and procalcitonin) and MRI evidence of an epidural empyema necessitates emergent surgical intervention to limit morbidity, neurological sequelae, and mortality.

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“…Laboratory studies usually show elevated WBC counts and increased ESR, CRP, and procalcitonin levels. [ 6 , 7 , 9 , 10 , 21 , 25 , 32 , 34 ]…”

Section: Discussionmentioning

confidence: 99%

All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

Brunasso

Basile

Iacopino

et al. 2020

Surgical Neurology International

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“…Spinal epidural empyema (SEE) is a serious condition that poses a significant challenge despite advances in diagnostic and treatment tools. [ 1 , 2 ] Although relatively rare, with an incidence of 1/10,000 hospital admissions,[ 3 ] there has been a significant increase in new cases in recent decades driven by an aging population, higher frequency of invasive procedures (including spinal instrumentation) and intravenous illicit drug consumption. [ 4 ] The linchpin of SEE treatment is prolonged antibiotic therapy directed against an isolated agent – a minimum of 6 weeks, with longer regimens in cases of refractory infection and failure to normalize inflammatory parameters.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of an all-spine epidural empyema

Reinas,

Alves,

Kitumba

et al. 2023

Journal of Craniovertebral Junction and Spine

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Spinal epidural empyema (SEE) is a severe infectious disease of the spine which may cause significant morbidity and mortality. Surgical drainage of the empyema is a key feature. However, approach-related morbidity may be significant in very extensive collections. We present the case of a 55-year-old female with an empyema due to methicillin-susceptible Staphylococcus aureus spawning from C2 to S1. She underwent drainage of the pus through skip-level laminectomies and catheter epidural saline irrigation. The technique described was both safe and effective at treating the SEE, and the patient returned to normal life.

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