Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess.
Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9-10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.
Turgut
M
M
Department of Neurosurgery, Adnan Menderes University Hospital, Aydin, Turkey. drmturgut@yahoo.com
D000208:Acute Disease; D000284:Administration, Oral; D002437:Cefazolin / Q000008:administration & dosage; D003646:Debridement; D015299:Discitis / Q000175:diagnosis / Q000601:surgery*; D017586:Diskectomy; D020802:Epidural Abscess / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010264:Paraplegia / Q000209:etiology*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology*; D020127:Recovery of Function; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002437:Cefazolin