P070: SPINAL EPIDURAL ABSCESS AFTER KNEE SURGERY: A CASE REPORT
Parneet Parekh; Kendall regional Hospital
Introduction: Spinal epidural abscess (SEA) is rare, and potentially fatal condition with only .88 cases reported in every 10,000 admissions. SEA often requires emergency neurosurgical decompression. Early diagnosis and treatment are essential for preventing permanent neurologic damage or even death. Initial symptoms include back pain and/or weakness in distal extremities. 45 yr female with recent knee surgery presents with progressive lower extremity weakness rapidly progressing to quadriparesis. On further investigation knee surgery was done under GA and imaging revealed a large epidural fluid collection in her cervical through lumbar spine. Neurosurgical evacuation revealed a large epidural abscess with cultures positive for Methicillin sensitive staphylococcus aureus (MSSA). This was suspected to be secondary to pneumonia. After surgical evacuation of the abscess and IV antibiotics the patient regained some sensation in her extremities, but unfortunately never recovered any motor strength.
Methods: Patient had an elective Knee surgery under general anesthesia with postoperative Adductor canal block
Results: patient was able to regain some sensation in her extremities after 1 day of decompressive surgery but unfortunately, she never recovered any motor strength.
Conclusion: The posterior epidural space is large and contains many arteries, veins, and fat tissue. Most infections are reported in the large posterior thoracolumbar epidural space . Abscess may cause spinal cord ischemia [1, 4, 5, 9]. The cause of epidural abscess is not specific in 30% of the cases, whereas 10-20% is reported for hematoma, osteomyelitis and drug abuse. Most common cause of a SEA is Staphylococcus aureus. [8, 9]. Rarely skin infections, UTIs, pneumonia, dental infections have also been shown to precede epidural abscesses. Outcome of the patient largely depends on the type of abscess and time for onset of symptoms. Patients with four days of onset have 90% mortality rate, and 67% for seven day . Symptoms lingering more than 24 hours are associated with poor neurological recovery [5, 9].
The patient had no predisposing risk factors for development of SEA besides a pneumonia found on chest X-ray at the time of admission. Her right knee was healing well from surgery with no evidence of swelling, redness or any other signs of infection. She had no invasive spinal procedures done. Blood cultures matched the abscess cultures in identification of MSSA. We believe pneumonia was developed at the patient’s most recent hospital stay for her right knee surgery.
Prognosis after a SEA is correlated with time of abscess development and onset of treatment. Unfortunately, the patient involved started with symptoms of an SEA about 7 days before care was sought leading to a poor prognosis in neurological recovery.
It is important to quickly recognize the clinical signs and symptoms of back pain, paresthesia and weakness especially in young adults . There is only short time in which intervention and treatment can yield neurological recovery. Therefore, quick evaluation, diagnosis and treatment is profound in each case of SEA as this case delayed course proved very poor prognosis.