Skip Navigation LinksHome > January 1, 2004 - Volume 29 - Issue 1 > Cervical Epidural Abscess After Epidural Steroid Injection
Spine:
Case Report

Cervical Epidural Abscess After Epidural Steroid Injection

Huang, Russel C. MD*; Shapiro, Gary S. MD*; Lim, Moe MD*; Sandhu, Harvinder S. MD*; Lutz, Gregory E. MD†; Herzog, Richard J. MD‡

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Abstract

Study Design. This is a case report of a cervical epidural abscess presenting with neurologic deficits after cervical epidural steroid injection.

Objective. To describe the presentation, diagnosis, treatment, and outcome of a rare complication of cervical epidural steroid injection.

Summary of Background Data. Cervical epidural steroid injections are a commonly used modality in the treatment of cervical spine disease. Serious complications from the procedure are rare. There is only one previously reported case of cervical epidural abscess after cervical epidural injection in the literature.

Materials and Methods. A case of cervical epidural abscess after epidural steroid injection is presented and the relevant literature is reviewed.

Results. The patient had partial recovery of neurologic function within the first 24 hours after decompressive laminectomy, irrigation, and debridement. There were no perioperative complications. Intraoperative cultures permitted positive identification of the infecting organism and appropriate antibiotic selection. At 7-month follow-up, there was no recurrence of infection and the patient had recovered baseline neurologic function and neck pain status.

Conclusions. Cervical epidural abscess is a rare but potentially devastating complication after epidural steroid injection. Neurologic compromise may occur. Timely diagnosis and appropriate treatment may result in good clinical outcomes.

Cervical epidural steroid injections (ESI) are a commonly used modality in the treatment and diagnosis of painful diseases of the cervical spine. The reported incidence of complications is low, and major complications are exceedingly rare. 13,17 Waldman reported a series of 790 cervical ESIs in 215 patients who were followed-up prospectively for 6 weeks after the procedure. Three patients had major complications and three had minor complications. The rate of complications per ESI was 0.8%, whereas the incidence of major complications was 0.4%. There were no epidural abscesses in this series.

Waldman 17 reported in a letter a single case of cervical epidural abscess after ESI. To our knowledge, there are no other reports of this rare entity in the literature. We report on the presentation, diagnosis, treatment, and outcome of a patient who presented with cervical epidural abscess and neurologic compromise after cervical ESI.

© 2004 Lippincott Williams & Wilkins, Inc.

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