[Chronic spinal epidural abscess (author's transl)].

A case of 58 year old female with chronic spinal epidural abscess demonstrating rapid progression of complete spinal cord paralysis without remarkable recovery by laminectomy was reported. Patient had a large subcutaneous abscess on left back, ten years ago. Three months before admission she fell down from stairs and had a compression fracture on the seventh thoracic vertebra. She has been troubled with slight spinal ache and left lower back pain since the fall accident. One month before admission she suddenly noted severe lower back pain with radiation to left side and the pain became more severe. Three weeks after she noted fecal retention without urinary retention. Five days before admission she noted gait disturbance accompanied by numbness of both foots. Three days later she developed inability to urinate and the same day, over the coure of a few hours, she became total paraplegia and anesthesia below the waist. On admission neurological examination and myelography disclosed complete spinal subarachnoid block with flaccid total paraplegia and anesthesia below the lower chest. The clinical diagnosis was spinal epidural mass lesion, probably neoplasm. Laminectomy from Th-6 through Th-9 was performed the next day: three days after complete paralysis. The epidural abscess included pus and soft granulation tissue was found and totally removed. Staphylococcus aureus sensitive to penicillin, chloramphenicol etc. was isolated on becteriologic culture. On seven months after operation, sensory and deep reflexes were considrable improved, but she remained paraplegic without sphincter control. Dicussion were made on the incidence, pathogenesis.