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Multifocal Metachronous Epidural Abscesses of the Spine: A Case Report

Chow, Gregory H., MD; Gebhard, James S., MD; Brown, Courtney W., MD

Case Report

Study Design A retrospective case report of a patient who had a lumbar epidural abscess treated surgically who then developed a cervical epidural abscess that also required surgical treatment.

Objectives To describe a patient in whom treatment of a single epidural abscess with surgery and antibiotics was not sufficient to eradicate the systemic infection.

Summary of Background Data Epidural abscesses are most commonly seen after invasive procedures that violate the epidural space. Epidural abscesses are usually a solitary event occurring in only one location and are usually treatable with surgical drainage and parenteral antibiotics.

Methods An elderly patient presented with neck and shoulder pain and fever. Evaluation revealed degenerative disease of the cervical spine. Within a week, she developed a cauda equina syndrome secondary to a lumbar epidural abscess. The abscess was drained and intravenous antibiotics were given. Seventeen days later, while still receiving antibiotics, she developed a cervical epidural abscess which also required surgical drainage.

Results The patient showed gradual improvement in her neurologic status. No recurrence of either epidural abscess was observed.

Conclusions An epidural abscess may represent a serious systemic infection that requires aggressive treatment. Close follow-up is necessary to ensure that the infection has been eradicated and that no recurrent abscess has formed in the same or a different location. Aggressive antibiotic treatment is also strongly recommended.

From the Lakewood Orthopaedic Clinic, 1805 Kipling St., Lakewood, CO 80215.

This work was not financially or materially supported.

Acknowledgment date: February 27, 1995.

First revision date: July 24, 1995.

Acceptance date: September 19, 1995.

Device status category: 10.

Address reprint requests to: James S. Gebhard, MD; The Lakewood Orthopaedic Clinic; 1805 Kipling St; Lakewood, CO 80225

© 1996 by Lippincott Williams & Wilkins