Neurológia pre prax 4/2009

Options of surgical treatment of spinal epidural abscess

Spinal epidural abscess is a very rare condition that may, in the case of delayed diagnosis and intervention, result in a serious or even permanent disability of the patient. In 2007, two patients were managed at the Department of Neurosurgery in Nové Zámky. Based on a comprehensive examination including neurological, radiological and laboratory studies, severe lower limb paraparesis/plegia was found which evolved within 24–48 hours with accompanying fever and elevated inflammatory markers (sedimentation rate, leukocytosis, elevated CRP). Magnetic resonance imaging showed a collection in the epidural space of the thoracic spine with compression of the spinal cord. Given the significant motor deficit, an urgent surgical procedure was decided upon with the aim of decompression of the neural structures and evacuation of pus, which resulted in reducing and/or resolving the permanent disability. Despite its low incidence, the diagnosis of spinal epidural abscess needs to be kept in mind during the differential diagnostic process for a rapidly developing neurological deficit.

Keywords: spinal epidural abscess, laminectomy, decompression.