Concomitant epidural and subdural spinal abscess: a case report

Abstract Background Context Spinal subdural abscess (SSA) is a rare occurrence for which the management typically involves open surgical removal and washout. Purpose This case report aims to review the literature and discuss the management of patients with SSA. Study Design We present a case of a 33...

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Bibliographic Details
Published in:The spine journal 2016-04, Vol.16 (4), p.e275-e282
Main Authors: Ngwenya, Laura B., MD, PhD, Prevedello, Luciano M., MD, MPH, Youssef, Patrick P., MD
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Empyema, Subdural - complications
Empyema, Subdural - diagnosis
Empyema, Subdural - drug therapy
Empyema, Subdural - surgery
Epidural Abscess - complications
Epidural Abscess - diagnosis
Epidural Abscess - drug therapy
Epidural Abscess - surgery
Epidural Space
Female
Humans
Intravenous drug use
Laminectomy - adverse effects
MRI
Orthopedics
Spinal epidural abscess
Spinal infection
Spinal subdural abscess
Subdural Space
Surgical management
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Summary:Abstract Background Context Spinal subdural abscess (SSA) is a rare occurrence for which the management typically involves open surgical removal and washout. Purpose This case report aims to review the literature and discuss the management of patients with SSA. Study Design We present a case of a 33-year-old female who presented with a spinal epidural abscess and concurrent SSA. She presented in the context of intravenous (IV) drug use, back pain, and generalized lower extremity weakness. Methods The literature was reviewed with a focus on modern treatment options for SSA. Our patient was managed with IV antibiotics, and separate laminectomies and washouts for both lesions. Results The patient recovered well with return of neurologic function and normalization of infection markers. The review of the literature resulted in a management flowchart that will help direct treatment of SSA. Conclusions The literature suggests that in a patient with a definitive diagnosis of SSA, limited surgical management and IV antibiotics are the mainstay of treatment in a patient with a decline in neurologic function. There may be a role for expectant management in the absence of diagnostic imaging or the neurologically stable patient.
ISSN:1529-9430
1878-1632
DOI:10.1016/j.spinee.2015.11.060