Concomitant epidural and subdural spinal abscess: a case report

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• 作者：Laura B. Ngwenya ; MD ; PhD^a ; ¹ ; Luciano M. Prevedello ; MD ; MPH^b ; Patrick P. Youssef ; MD^a ; ^{Patrick.Youssef@osumc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Intravenous drug use ; MRI ; Spinal epidural abscess ; Spinal infection ; Spinal subdural abscess ; Surgical management
• 刊名：The Spine Journal
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：16
• 期：4
• 页码：e275-e282
• 全文大小：1163 K

文摘

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.