Spinal Epidural Abscess Complicated by Saddle Pulmonary Embolism: A Case Report

Area of Science:

• Neurosurgery
• Cardiology
• Critical Care Medicine

Background:

• Spinal epidural abscesses can lead to severe neurological deficits.
• Concurrent pulmonary embolism presents a significant management challenge, especially when urgent surgical intervention is required.
• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers cardiopulmonary support but its use in patients requiring urgent spinal decompression with concomitant pulmonary embolism is not well-established.

Purpose of the Study:

• To report a rare case of managing a patient with a large spinal epidural abscess and submassive pulmonary embolism.
• To demonstrate the feasibility and safety of using VA-ECMO to facilitate urgent spinal decompression in this complex clinical scenario.
• To evaluate the impact of this multidisciplinary approach on neurological and cardiopulmonary outcomes.

Main Methods:

• A 36-year-old female with a history of intravenous drug use presented with paraplegia and urinary incontinence.
• Diagnostic workup included MRI revealing a C5-T1 ventral cervical spinal epidural abscess and CT angiography showing a saddle pulmonary embolism with right heart strain.
• Management involved initiating VA-ECMO without anticoagulation, followed by urgent C6 corpectomy and anterior decompression/fusion (C5-T1), with subsequent anticoagulation and thrombectomy.

Main Results:

• The patient successfully underwent urgent spinal decompression while supported by VA-ECMO.
• Neurological deficits were addressed, and cardiopulmonary stability was maintained throughout the perioperative period.
• Postoperative anticoagulation and thrombectomy were performed without immediate complications.

Conclusions:

• This case illustrates that VA-ECMO can be safely employed to enable urgent spinal decompression in patients with concurrent submassive pulmonary embolism.
• This approach can optimize both neurological recovery and cardiopulmonary function.
• Multidisciplinary management is crucial for successful outcomes in such complex cases.