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[Dorsal subdural spinal abscess after epidural anesthesia]

M Barón1, J Heredero, I Prieto

  • 1Servicio de Neurología, Hospital Ramón y Cajal, Madrid.

Neurologia (Barcelona, Spain)
|June 1, 1997
PubMed
Summary

Spinal subdural empyema (SE) is a rare complication following lumbar epidural anesthesia. Complete surgical excision, alongside antibiotics, was crucial for recovery in a distant thoracic SE case.

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Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Anesthesiology

Background:

  • Spinal subdural empyema (SE) is an uncommon but serious infection of the space between the dura mater and the spinal cord.
  • Post-procedural SE, particularly after neuraxial techniques like epidural anesthesia, presents diagnostic and therapeutic challenges.
  • The latency and distant location of SE from the site of intervention can complicate early recognition.

Observation:

  • A case report of a young patient who developed thoracic spinal subdural empyema after undergoing lumbar epidural anesthesia.
  • The empyema was located significantly distant from the lumbar epidural puncture site.
  • Magnetic resonance imaging (MRI) proved instrumental in diagnosing the SE and monitoring treatment response.

Findings:

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  • Standard treatment with intravenous antibiotics and surgical drainage was insufficient to resolve the infection.
  • Complete surgical excision of the spinal subdural empyema was ultimately required for successful patient management.
  • This case highlights the potential for SE to occur at a site remote from neuraxial procedures.

    • Implications:

    • Early and accurate diagnosis of SE, even when distant from the initial procedure, is critical.
    • Aggressive surgical management, including complete lesion excision, may be necessary when conservative treatments fail.
    • Awareness of this rare complication is important for clinicians performing epidural anesthesia and managing spinal infections.