Spinal Epidural Abscess During a Spinal Cord Stimulation Trial in Complete Spinal Cord Injury: A Case Report

Area of Science:

• Neurology
• Neurosurgery
• Infectious Disease

Background:

• Chronic pain is a common challenge following spinal cord injury (SCI).
• Medications are often ineffective for SCI-related pain.
• Spinal cord stimulation (SCS) is an alternative therapy for refractory pain.

Purpose of the Study:

• To report a case of spinal epidural abscess (SEA) in a patient with complete thoracic SCI undergoing SCS.
• To highlight the diagnostic challenges of SEA in the context of SCI.
• To discuss the management of SCS-related SEA.

Main Methods:

• A case report of a 48-year-old male with complete thoracic SCI.
• The patient underwent an SCS trial for severe lower-extremity pain.
• Diagnostic workup included MRI, inflammatory markers, and cultures after symptom onset.

Main Results:

• SCS provided pain relief, but the patient developed fever, elevated inflammatory markers, and purulent drainage.
• MRI confirmed a spinal epidural abscess (SEA).
• Cultures identified methicillin-resistant Staphylococcus aureus; conservative treatment with vancomycin was successful.

Conclusions:

• Spinal epidural abscess (SEA) is a rare but serious complication of SCS.
• Diagnosing SEA in patients with complete SCI can be challenging due to overlapping symptoms.
• Early recognition and appropriate antibiotic therapy are crucial for successful management of SCS-related SEA.