Not All Back Pain Is Muscle Strain: A Case of Epidural Abscess

Epidural abscesses are rare suppurative abscesses of the central nervous system that can expand and lead to severe neurologic complications and even death. Here we describe the case of a 68-year-old female who developed a spinal epidural abscess one month following cervical spinal decompression and fusion. The patient presented with decreased grip strength, flaccid paralysis of the lower extremities with hyporeflexia, urinary incontinence, and decreased sensation in the bilateral lower extremities. A cervical spine MRI revealed a large cervical spinal epidural abscess causing multilevel spinal cord compression that was treated with surgical evacuation and antibiotics. Due to the complications of epidural abscess, we as clinicians must have high clinical suspicion to initiate the correct treatment. In addition, patients without neurological symptoms or symptoms lasting less than 36 hours have the best recovery rate. Our case highlights the importance of timely diagnosis, management, and intervention, which can lead to restored functionality and the prevention of permanent neurologic sequelae.