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Spinal epidural abscess following blunt pelvic trauma
B M Boszczyk1, P Krause, H Bolay
1Spine Centre, München-Harlaching Orthopaedic Hospital, Munich, Germany. B.Boszczyk@GMX.net
Summary
A teenage patient with spondylolisthesis developed an epidural abscess after a fall. Prompt surgical drainage and antibiotics successfully treated the infection and resolved symptoms.
Area of Science:
- Orthopedics
- Infectious Disease
Background:
- A 17-year-old patient with pre-existing lumbar spondylolisthesis experienced a sacroiliac joint injury and iliac muscle hematoma after a fall.
- The hematoma potentially caused left ureteral obstruction, leading to a urinary tract infection.
Observation:
- The patient presented with fever and left leg radicular pain, unresponsive to initial conservative management.
- Magnetic resonance imaging (MRI) identified a left-sided epidural abscess at L5/S1, likely originating from the infected hematoma and spreading via the injured sacroiliac joint.
Findings:
- Surgical drainage of the epidural abscess and antibiotic therapy (cefuroxime and flucloxacillin) resulted in rapid clinical improvement.
- Staphylococcus aureus was identified as the causative pathogen.
- At 6-month follow-up, all symptoms resolved, though MRI showed residual sacroiliac joint osseous edema. The iliac hematoma resolved conservatively.
Implications:
- This case highlights the potential for severe infectious complications, including epidural abscesses, secondary to traumatic injuries in patients with pre-existing spinal conditions.
- Early surgical intervention and targeted antibiotic therapy are crucial for managing spinal epidural abscesses and achieving favorable outcomes.
- The case underscores the importance of comprehensive diagnostic imaging and prompt treatment for complex spinal trauma with associated infections.