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Intradural Extension of a Pyogenic Epidural Abscess: A Case Report

Philip J Rosinsky1, Oren Zimhony, Pnina Ciobotaro

  • 1Department of Orthopedic Surgery (P.J.R., S.S., and P. B.-G.) and Infectious Diseases Unit (O.Z. and P.C.), Kaplan Medical Center, Pasternak Street, P.O.B. 1, Rehovot 76100, Israel. prosinsky@gmail.com. Oren_Z@clalit.org.il. PninaCi@clalit.org.il. sagiv2524@gmail.com. pelegbg@gmail.com.

JBJS Case Connector
|December 19, 2017
PubMed
Abstract

Insights

Spinal epidural abscess can rarely extend into the dura, posing a surgical challenge. Prompt diagnosis and treatment, including surgery and antibiotics, are crucial for a positive outcome in these complex cases.

Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Spinal Cord Medicine

Background:

  • Spinal epidural abscesses (SEAs) are serious infections.
  • Intradural extension of SEA is a rare but significant complication.
  • Few documented cases exist of SEA with extradural abscess and intradural extension.

Purpose of the Study:

  • To describe a unique case of SEA with intradural extension.
  • To highlight the diagnostic and treatment challenges associated with this rare complication.
  • To emphasize the importance of early intervention for favorable outcomes.

Main Methods:

  • Case report detailing a unique presentation of SEA.
  • Description of extradural abscess with intradural extension through multiple dural perforations.
  • Management involved surgical decompression, debridement, and antibiotic therapy.

Main Results:

  • A unique complication of SEA involving pus extension through multiple dural perforations was observed.
  • No cerebrospinal fluid leak occurred due to a proximal meningeal inflammatory reaction acting as a plug.
  • The patient's condition was successfully managed with prompt surgical intervention and comprehensive treatment.

Conclusions:

  • Intradural extension of pus in SEA is a rare and challenging complication.
  • Early diagnosis and prompt surgical decompression are critical.
  • Aggressive debridement and prolonged antibiotic treatment are essential for favorable outcomes.

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