Spinal Abscess after Epidural Catheter Insertion: A Case Report

Abstract

Introduction Epidural anesthesia has become a common practice for treatment of acute surgical pain and to relieve chronic pain syndromes. Despite its many qualities, potential risks have been described. Spinal epidural abscess is one of its most perilous complications. Materials and Methods A 72-year-old patient was treated due to lung cancer. After the operation, the pain was worsening progressively for many months. As a pain relieving measure, an epidural catheter was inserted into the upper thoracic spinal canal. In the reconvalescent period, progressive weakness of lower extremities suddenly developed and advanced rapidly into paraplegia. There was no fever observed by the patient. Results At admission, hypoesthesia from the upper thoracic level and anesthesia from the lower thoracic level was observed, accompanied with paraplegia. Muscle tone was appropriate and Babinski sign was present bilaterally. MRI revealed epidural fluid formation at the posterior aspect of the spinal canal with an intense compression of the cord at levels Th1 to Th4. An immediate operation followed during which a wide decompression of the spinal cord with complete evacuation of the abscess was performed. In the epidural fluid collection, the tip of the epidural catheter was found. Appropriate antibiotic therapy was started instantly. From the abscess, Staphylococcus epidermidiswas isolated. Postoperative CT scan revealed sufficient decompression of the spinal cord. Unfortunately, initially promising recovery was complicated with pneumonia and lung cancer progression that led to the death of the patient. Conclusion Although rare, the epidural abscess is a dangerous complication, resulting in high morbidity and mortality despite rapid surgical and postoperative interventions. Clinical signs and symptoms may be confusing and may point to other forms of pathology. The importance of very strict sterile procedures during catheter insertion and removal or close monitoring of patients with inserted catheters cannot be overemphasized. Disclosure of Interest None declared References Stäbler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am 2001;39(1):115–135 Tompkins M, Panuncialman I, Lucas P, Palumbo M. Spinal epidural abscess. J Emerg Med 2010;39(3):384–390 Ugarriza LF, Porras LF, Lorenzana LM, Rodríguez-Sánchez JA, García-Yagüe LM, Cabezudo JM. Brucellar spinal epidural abscesses. Analysis of eleven cases. Br J Neurosurg 2005;19(3):235–240 von Albert HH. [Lumbalgia, lumboischialgia. 2: Instrumental diagnosis, differential diagnosis]. Fortschr Med 1990;108(18):363–364