Spinal epidural abscess: an unusual cause of sciatica

Area of Science:

• Infectious Diseases
• Neurosurgery
• Radiology

Background:

• Spinal epidural abscesses (SEAs) are serious infections requiring prompt diagnosis and treatment.
• Lower back pain and sciatica are common symptoms, often attributed to lumbar disc herniation.
• Delayed diagnosis of SEAs can lead to severe neurological deficits and increased morbidity.

Observation:

• A previously healthy patient presented with low back pain and sciatica, initially diagnosed as lumbar disc herniation.
• Despite non-steroidal anti-inflammatory drugs and bed rest, the patient developed symptoms of septic infection.
• Advanced imaging revealed a spinal epidural abscess and spondylodiscitis at the L5-S1 level.

Findings:

• Microbiological cultures identified Staphylococcus aureus in both epidural pus and blood samples.
• Emergency laminotomy successfully evacuated a significant amount of pus from the epidural space.
• The patient's presentation with predominantly sciatic pain delayed the diagnosis of SEA.

Implications:

• This case underscores the importance of considering SEA in patients with persistent or worsening back and leg pain, even with initial diagnoses of disc herniation.
• Staphylococcus aureus is a common pathogen in SEAs, necessitating appropriate antibiotic therapy.
• Early recognition and surgical intervention are crucial for favorable outcomes in spinal epidural abscesses.