title: Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess.
abstract: Extensive spinal epidural abscesses (SEAs) carry a high mortality rate. Traditionally they are treated non-operatively with long-term antibiotics and/or surgical decompression, but there is a continuing debate as to whether they should be managed by emergency surgical decompression. However, such decisions are made in the light of the clinical setting. We report the successful management of a female patient who presented with features of upper cervical cord compression and later developed septic shock and multisystem failure. Surgical decompression of the cervical spine and irrigation of the epidural space with a paediatric catheter was performed followed by tricortical strut grafting and plating. At review, 36 weeks after surgery, the patient remained asymptomatic, having made full neurological recovery. The purpose of this report is to highlight the importance of emergency surgical intervention for extensive SEA in the presence of progressive neurological loss associated with multisystem failure.
authors.affiliation: Centre for Spinal Studies and Surgery, University Hospital, Queen's Medical Center, Nottingham, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Lam
authors.forename: K C
authors.initials: KC
authors.lastname: Pande
authors.forename: H
authors.initials: H
authors.lastname: Mehdian
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004824:Epidural Space / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents