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Unexpectedly rapid decrease in the size of a spinal epidural abscess after percutaneous posterior pedicle screw

Go Kubota^1,2, Yasuchika Aoki^3,4, Yusuke Sato^1,5

¹Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.

Spinal Cord Series and Cases

|August 13, 2022

Summary

Percutaneous pedicle screw fixation without decompression successfully treated spondylodiscitis with spinal epidural abscess and severe leg pain. This spinal stabilization technique offers an alternative to surgery, leading to rapid abscess reduction and symptom improvement.

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Area of Science:

Neurosurgery
Orthopedic Surgery
Infectious Disease

Background:

Spondylodiscitis with spinal epidural abscess (SEA) often necessitates decompression surgery for neurological deficits.
Conservative management with antibiotics may be insufficient for worsening symptoms and abscess expansion.

Observation:

A 53-year-old male presented with severe low back pain, lower extremity pain, numbness, and fever.
MRI revealed L2-L3 spondylodiscitis and a ventral epidural abscess, which expanded despite initial antibiotic treatment.
Percutaneous posterior pedicle screw fixation was performed without spinal decompression.

Findings:

Post-fixation, low back pain and lower extremity symptoms significantly improved.
Postoperative MRI demonstrated rapid epidural abscess size reduction without decompression.
The epidural abscess completely resolved within two months, with no recurrence at five-year follow-up.

Implications:

Percutaneous pedicle screw fixation without decompression is a viable treatment option for spondylodiscitis with SEA and lower extremity symptoms.
Spinal stabilization via pedicle screw fixation may aid in controlling spinal infections.
This approach may avoid the risks associated with extensive decompression surgery.