Thoracic Spinal Epidural Abscess After Spinal Cord Stimulation Trial With Cord Compression but Preserved Neurologic...

Spinal cord stimulation (SCS) is an effective therapeutic option for refractory neuropathic pain, but infectious complications, particularly epidural abscess, are rare and carry high morbidity. Evidence describing the inpatient rehabilitation course following urgent surgical decompression in patients with radiographic cord compression but largely preserved neurologic function remains limited, and standardized functional outcomes are seldom reported. We present the case of an 84-year-old woman with severe dextroscoliosis, kyphosis, and chronic axial back pain who underwent an outpatient SCS trial. Five days later, on the day of lead removal, she presented with fever (maximum temperature 38.5 °C), tachycardia, leukocytosis (white blood cell count 11.58 K/μL), markedly elevated inflammatory markers (C-reactive protein 312 mg/L on repeat testing after an initial erroneously high reading, procalcitonin 10.11 ng/mL, and erythrocyte sedimentation rate 63 mm/hr), and urinary retention. Thoracic MRI demonstrated a dorsal-predominant epidural collection from T8-T12 with cord compression and adjacent paraspinal cellulitis. She underwent urgent T8-T12 decompressive laminectomies and was treated for methicillin-resistant Staphylococcus aureus bacteremia with daptomycin. Following acute care, she completed a 23-day inpatient rehabilitation admission. Functional progress was tracked with the seven-point functional independence measure (FIM). The FIM motor sub-score improved from 47 on admission to 68 on discharge (a 21-point gain). Pain, monitored with the Numeric Rating Scale (NRS), decreased from 6/10 on admission to 2/10 on discharge with a multimodal analgesic regimen. By discharge, she ambulated 300 feet independently without an assistive device and was modified independent on 12 steps. This case suggests that inpatient rehabilitation may be safely delivered to selected older adults with radiographically severe but clinically preserved post-SCS epidural abscess. It also supports the routine reporting of FIM-based outcomes in this rare scenario.