Successful treatment of extended epidural abscess and long segment osteomyelitis: a case report and review of the literature.
BACKGROUND
Spinal osteomyelitis and epidural abscess are complicated medical conditions. Diagnosis is often delayed because of cormorbidity. The time of instrumentation is still controversial. However, there is no doubting the indication of spinal hardware implantation when spinal fusion is needed. Long segment osteomyelitis and extended epidural abscess are rare. The treatment is challenging for neurosurgeons. We report a case of extended epidural abscesses and long segments of osteomyelitis.


METHODS
One-stage meticulous debridement, anterior cervical corpectomies, and spinal fusion with mesh cage and titanium plate were performed on the patient. Hyperbaric oxygenation and 6 weeks of intravenous antibiotics were prescribed as adjuvant therapy.


RESULTS
Both clinical presentations and imaging studies showed a good response to the treatment. The patient returned to his life 3 months later.


CONCLUSIONS
This case illustrates that spinal instrumentation is not an absolute contraindication in the presence of epidural abscesses and vertebral osteomyelitis. Combined surgical debridement at a critical level, with adjuvant antibiotics and hyperbaric oxygenation, is a safe and effective therapy in those with neurologic deficits, spinal instability, and extended epidural abscess.
Chang
Wei-Chieh
WC
Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan 407, Republic of China.
Tsou
Hsi-Kai
HK
Kao
Ting-Hsien
TH
Yang
Meng-Yin
MY
Shen
Chiung-Chyi
CC
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002574:Cervical Vertebrae; D020802:Epidural Abscess / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D010068:Oxacillin / Q000008:administration & dosage; D013123:Spinal Fusion / Q000379:methods*; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*