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

Chronic pain after spinal cord injury (SCI) is often refractory to medication, and spinal cord stimulation (SCS) may provide relief. We report a 48-year-old man with complete thoracic SCI who underwent an SCS trial for severe bilateral lower-extremity-pain. Although pain improved, low-grade fever, elevated inflammatory markers, and purulent drainage developed on day 7. Magnetic resonance imaging revealed a spinal epidural abscess (SEA). SCS leads were removed, and cultures grew methicillin-resistant Staphylococcus aureus. As the abscess was small without significant compression, conservative treatment with vancomycin was successful. This case highlights the diagnostic difficulty of SEA in complete SCI.