Romanian Neurosurgery (Dec 2023)
Huge extradural multilevel lumbar abscess
Abstract
Extensive spinal epidural abscesses (ESEAs), occupying three or more spinal regions, are rare forms of vertebral infection. Multilevel laminectomy in these cases is controversial because of the risk of vertebral instability. We report the case of a 47-year-old patient known with ureterohydronephrosis 2nd degree, admitted for severe vertebral pain (VAS 8/10) from 2 months, paraparesis (ASIA 1/5 left, 4/5 right, retention of urine and faeces) from three days. The analysis discovered Diabetes Mellitus type 2, and high levels of inflammatory tests. CT and MRI of the vertebral area with contrast revealed dorsal compression of the spinal cord and cauda equina by an epidural abscess extending from L1-L5, bilateral in the soft adjacent paravertebral tissues especially psoas muscles but sparing the intervertebral discs. Surgical treatment: alternate fenestrations L1-L5, more important on the left side. By this technique, we removed the fluid pus and also granulomatous pus from posterior epidural space L1-L5, bilateral medial foramina, interspinous and supraspinous space, and psoas muscles. The identified germ was Staphylococcus aureus ++++. Postoperatively, we used a continuous drainage washing system with Vancomicyne and diluted Betadine—a course of six-week Vancomycin 2 grams/day iv. The drainage system was blocked after 24 hours and we had to remove it and all the wires of the suture. We had to dress up every day for the surgical field and wash deep inside the field with diluted betadine for 3 weeks till the surgical field was completely cured. After 3 months postoperatively the patient was cured radiologically and clinically. Follow up 18 months. Conclusion: alternate fenestration has the advantages of removing liquid and granulomatous pus in the epidural posterior area and preserving the spine stability.
