Review of 10 Cases of Pyogenic Epidural Abscess of the Spine

ABSTRACT

Spinal epidural abscess is a rare disorder with poor prognosis. In order to understand its clinical feature and method of treatment, a retrospective study of spinal epidural abscess spanning 8 years and encompassing 10 patients was done. There were 6 males and 4 females aged 12 to 64 years with peak incidence at the sixth decade. In one patient, epidural abscess recurred at the site previously treated 10 years ago. In addition to fever and leukocytosis in 8 patients, other frequent symptoms according to lesion site were abdominal pain and motor weakness in thoracic epidural abscess and low back pain and sciatica in lumbar epidural abscess. Staphylococcus aureus was the most common causative organism. Magnetic resonance imaging(MRI) showed variable signal on T1-weighted images and hyperintensity on T2-weighted images, which was studied in 6 patients. Two patterns in gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhancement(2 patients) gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhanement(2 patients) and heterogeneous enhancement(4 patients). MRI offered the advantage of noninvasive early recognition and anatomical localization, which made it the imaging modality of choice. Although laminectomy was the standard operative procedure, the result of window laminectomy with catheter drainage for prevention of kyphosis was proven effective in a girl. Complete improvement following surgery was obtained in patients, while a man resulted in paraplegia and a boy paraparesis with mild kyphosis in thoracic abscess as sequelae.