title: Extensive spinal epidural abscess associated with an unremarkable recovery.
abstract: Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.
authors.affiliation: Department of Orthopaedics, University College Hospital, Grafton Way, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Ansari
authors.forename: D W L
authors.initials: DW
authors.lastname: Davies
authors.forename: J W G
authors.initials: JW
authors.lastname: Lohn
authors.forename: P
authors.initials: P
authors.lastname: Culpan
authors.forename: G
authors.initials: G
authors.lastname: Etherington
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000175:diagnosis / Q000628:therapy; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D020802:Epidural Abscess / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents