Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

Abstract

Case seriesPatient: Male, 87 • Male, 62Final Diagnosis: Spinal subdural abscessSymptoms: Fever • pain • weaknessMedication: —Clinical Procedure: Laminectomy • durotomy • drainage • debridementSpecialty: NeurosurgeryObjective:Rare diseaseBackground:Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery.Case Report:Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3–4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery.Conclusions:These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

Spinal Subdural Abscess Following Food Intoxication: A Case Report

“…The mechanism of infection for SSA is considered as follows: (1) hematogenous spread from a distant site, (2) direct spread from an adjacent infection, (3) iatrogenic sources, and (4) unknown 1) .…”

“…The majority of the patients with SSA may have one or more predisposing conditions, such as diabetes mellitus, alcoholism, immunosuppressive drugs, chronic renal failure, malignant tumors, intravenous drug abuse, rheumatic heart valve disease, and tuberculosis 5) . In addition, a large group of patients had preexisting spinal disease, and all of these patients had surgery or injections performed 1) . We describe here a case of SSA following food intoxication in a 42-year-old man with no significant comorbidities who presented with prolonged fever, severe low back pain (LBP), and difficulty in urination.…”

“…Ramos et al stated that only 66 cases in adults have been reported in the English language literature by 2016 1) . Another author described that only just a hundred cases have been reported, which are much less common than spinal epidural abscess 2) .…”

Spinal Subdural Abscess following Transforaminal Lumbar Interbody Fusion

“…Subdural abscesses are suppurative infections of the space between the dura and arachnoid. Spinal subdural abscesses are rare lesions [1]. Bacterial abscesses involving the spinal canal are associated with high morbidity and mortality [2].…”

Comparing Pain Intensity after Surgery for Patients with Spinal Stenosis using with and without Instrumentation

“…Since spinal cord stenosis leads to narrowing bony canal, the objective is to open he bony canal in order to improve and increase the space for nerves. This action is named decompression surgery or laminectomy [13]. In this common surgery, the surgeon removes the pressure caused by bone segments and ligaments.…”