title: Quadriplegia caused by an epidural abscess occurring at the same level of cervical destructive spondyloarthropathy: a case report.
abstract: Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA.
  
  
  
  A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently.
  
  
  
  Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.
authors.affiliation: Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Republic of Korea. junband@naver.com.
authors.forename: Jun-Seok
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Republic of Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Republic of Korea.
authors.forename: Jong-Tae
authors.initials: JT
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Republic of Korea.
authors.forename: Ki-Won
authors.initials: KW
authors.lastname: Kim
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D020802:Epidural Abscess / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D011782:Quadriplegia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D020127:Recovery of Function; D025242:Spondylarthropathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Case report; Cervical spine; Destructive spondyloarthropathy; Epidural abscess; Hemodialysis; Quadriplegia; Spondylitis