Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report

Abstract

The incidence of a spinal epidural abscess (SEA), which can cause serious neurological complications, is low; however, the incidence of SEA caused by Streptococcus is even lower, most of which are reported in the thoracolumbar spine and lumbosacral segment. We reported a case of cervical SEA caused by Streptococcus constellatus infection, resulting in paralysis of the patient. The acute onset of SEA in a 44-year-old male led to decreased upper limb muscle strength, lower limb paralysis, and loss of bowel and bladder function, and imaging and blood tests suggested pyogenic spondylitis. Emergency decompression surgery and antibiotic therapy were given, the patient gradually recovered, and the muscle strength of the lower limbs gradually improved. This case report suggests the importance of early decompressive surgery and effective antibiotic therapy.

Letter to Editor Regarding: “Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus Constellatus Leads to Paraplegia in an Adult: A Case Report” [Letter]

“…Our comments should not be interpreted as diminishing the significance of the paper by Zhang et al 1 On the contrary, we fully endorse the conclusion that prompt surgical intervention and effective antibiotic therapy are imperative for achieving favorable outcomes in this challenging disease.…”

“…The existing literature supports the understanding that such a combination of clinical and paraclinical features should prompt the consideration of SEA as part of the differential diagnosis. 4 Our comments should not be interpreted as diminishing the significance of the paper by Zhang et al 1 On the contrary, we fully endorse the conclusion that prompt surgical intervention and effective antibiotic therapy are imperative for achieving favorable outcomes in this challenging disease.…”

“…After carefully reviewing the article by Zhang et al with great interest, we would like to provide some necessary clarifications to the readers of your esteemed journal. 1 Spontaneous spinal epidural abscesses (SEA) can be classified into two types: a) primary, which originates from a remote focal infection by hematogenous spread (arterial or venous) or direct infiltration into the epidural space through lymphatic vessels, and b) secondary, which arises per continuitatem from an adjacent infection (such as spondylodiscitis or paravertebral abscess). 2 In primary spinal epidural abscesses, there is no involvement of the vertebral bodies and intervertebral discs, while in secondary spinal epidural abscesses there is bone destruction as a result of spondylodiscitis.…”