Spinal Epidural Abscess and Psoas Abscess Combined with Pyogenic Spondylodiscitis Following Vertebroplasty: A Case Report

ABSTRACT

STUDY DESIGN: Case report. OBJECTIVES: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitis after a L3 vertebroplasty. SUMMARY OF LITERATURE REVIEW Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinal epidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the English medical literature. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever, and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstrated an extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guided percutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identified by intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. The infection was successfully treated without any neurologic deficit and spinal deformity. CONCLUSIONS: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgical decompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment option in spinal epidural abscess combined with pyogenic spondylodiscitis.