Spinal epidural abscess: a report of nine cases and the use of intra-operative ultrasonography.

BACKGROUND

Spinal epidural abscess is an uncommon and dangerous lesion. Once neurological complications occur the damage is often irreversible.

METHODS

The clinical presentation, operative findings, management and follow up of nine cases of spinal epidural abscess were reported. Four patients were diabetic and four others were intravenous drug addicts. The last patient had a history of a protracted stay in an intensive care unit complicated by pneumonia and pleural effusion. Ultrasonography was used intraoperatively to guide and to assess the adequacy of drainage and decompression of the epidural abscess.

RESULTS

Multiple level laminectomy was necessary and Staphylococcus aureus was the most common organism cultured. None of the five patients presenting with acute complete paralysis regained neurological function. Two of the four patients with incomplete paralysis were able to walk with an aid.

CONCLUSIONS

Spinal epidural abscess usually presents late and the prognosis is generally poor. Ultrasound may be useful in determining the extent of the abscess during operation to drain the collection.