Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature.
OBJECTIVE
We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy.


METHODS
A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. Blood cultures yielded Staphylococcus aureus. Magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine.


METHODS
The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment.


CONCLUSIONS
Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.
Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan. lyu5172@adm.cgmh.org.tw
Rong-Kuo
RK
Lyu
Chi-Jen
CJ
Chen
Lok-Ming
LM
Tang
Sien-Tsong
ST
Chen
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D015296:Ceftizoxime / Q000008:administration & dosage / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000150:complications / Q000628:therapy*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D004322:Drainage / Q000379:methods*; D020802:Epidural Abscess / Q000150:complications / Q000628:therapy*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D009339:Needles; D010068:Oxacillin / Q000008:administration & dosage / Q000627:therapeutic use; D010166:Palliative Care; D010406:Penicillins / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000150:complications / Q000628:therapy*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D015296:Ceftizoxime; D010068:Oxacillin