Spinal Cord Compression due to an Iatrogenic Lumbar Epidural Abscess

Abstract

The development of epidural abscess after intermittent epidural administration of local anesthetics and steroids is a rare condition with an unknown incidence. Magnetic Resonance Images (MRI) offers the appropriate approach to determine its effects on the spinal canal. A 60-year-old woman with a diagnosis of central disc at L4-L5, with sciatic pain in the left leg, was treated by means of two consecutive single-shot epidural injections of local anesthetic and depo-steroids with a time span of one week between them, 72 hours after the second injection, local infection developed, but after 17 days of antibiotic therapy the back pain worsened, with weakness and areflexia in both legs, as well as fever and normocytic anemia. At this stage, the patient was referred to our hospital where emergency MRI revealed an epidural abscess at L2- L3 level, and was taken to the emergency operating room where a laminectomy for emergent decompression and drainage of the abscess was performed. Symptoms improved in the immediate postoperative period, with 4/5-knee flexion, but sciatic pain persisted. Conclusion: Epidural abscess is rare condition if correct methodology is applied, but failure to promptly diagnose and treat it may be associated with a poor outcome, Magnetic Resonance Images being the diagnostic method of choice.