title: Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections--a rare cause of progressive paraparesis.
abstract: The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis. We demonstrate the rare cause of this progressive deterioration, being a combination of a preexisting chronic aseptic epidural abscess and an iatrogenic enlargement by repeated epidural injections. MR-Scans demonstrated a mass lesion at the L4/5 vertebral level, which was surgically removed. Histological evaluation revealed the presence of a chronic aseptic spinal epidural abscess with acute bleedings. Histology and MR-Data disclosed multiple deposits of the applied drug within the abscess and in the surrounding paravertebral soft tissue. The authors prove that the cause of the neurological deterioration was due to epidural injections into a preexisting lumbar chronic aseptic epidural abscess. Harmful and unpleasant complications may occur following epidural injections. Though we present a very rare cause of such complications, a careful monitoring of the neurological status of the patient is necessary as well as the early application of MR imaging in the case of deterioration.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf. Sabel@uni-duesseldorf.de
authors.forename: M
authors.initials: M
authors.lastname: Sabel
authors.forename: J
authors.initials: J
authors.lastname: Felsberg
authors.forename: E
authors.initials: E
authors.lastname: Neuen-Jacob
authors.forename: A
authors.initials: A
authors.lastname: Lichota
authors.forename: A
authors.initials: A
authors.lastname: Schnitzler
authors.forename: J
authors.initials: J
authors.lastname: Herdmann
mesh_terms: D018450:Disease Progression; D020802:Epidural Abscess / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D017116:Low Back Pain / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D013256:Steroids