Multifocal metachronous epidural abscesses of the spine. A case report.

STUDY DESIGN

A retrospective case report of a patient who had a lumbar epidural abscess treated surgically who then developed a cervical epidural abscess that also required surgical treatment.

OBJECTIVES

To describe a patient in whom treatment of a single epidural abscess with surgery and antibiotics was not sufficient to eradicate the systemic infection.

SUMMARY OF BACKGROUND DATA

Epidural abscesses are most commonly seen after invasive procedures that violate the epidural space. Epidural abscesses are usually a solitary event occurring in only one location and are usually treatable with surgical drainage and parenteral antibiotics.

METHODS

An elderly patient presented with neck and shoulder pain and fever. Evaluation revealed degenerative disease of the cervical spine. Within a week, she developed a cauda equina syndrome secondary to a lumber epidural abscess. The abscess was drained and intravenous antibiotics were given. Seventeen days later, while still receiving antibiotics, she developed a cervical epidural abscess which also required surgical drainage.

RESULTS

The patient showed gradual improvement in her neurologic status. No recurrence of either epidural abscess was observed.

CONCLUSIONS

An epidural abscess may represent a serious systemic infection that requires aggressive treatment. Close follow-up is necessary to ensure that the infection has been eradicated and that no recurrent abscess has formed in the same or a different location. Aggressive antibiotic treatment is also strongly recommended.