J Korean Soc Spine Surg.  2014 Jun;21(2):90-96. 10.4184/jkss.2014.21.2.90.

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

• Park JS
• Kim DH
• Kang BJ
• Jeong ST

• KMID: 1800404
• DOI: http://doi.org/10.4184/jkss.2014.21.2.90

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.

Keyword

spinal epidural abscess; psoas abscess; pyogenic spondylodiscitis; vertebroplasty; complication

MeSH Terms

Abscess
Aged
Congenital Abnormalities
Decompression, Surgical
Discitis*
Drainage
Early Diagnosis
Epidural Abscess*
Female
Fever
Hospitalization
Humans
Kyphoplasty
Laminectomy
Leg
Low Back Pain
Magnetic Resonance Imaging
Methicillin-Resistant Staphylococcus aureus
Neurologic Manifestations
Psoas Abscess*
Rifampin
Vancomycin
Vertebroplasty*
Rifampin
Vancomycin

Figure

• 

  Fig. 1. MRI before vertebroplasty demonstrated compression fracture of L3 body with epidural hematoma and old compression fracture of T11 body. There was no evidence of infection.

• 

  Fig. 2. Initial anteroposterior and lateral radiographs of the lumbar spine demonstrate L3 vertebroplasty without definite bony lesion.

• 

  Fig. 3. T2 weighted sagittal MR image demonstrates high signal intensity of L3-4 body and epidural space and subcutaneous space (A). Enhanced T1 weighted MR images demonstrate low signal intensity with ring-like peripheral rim enhancement of epidural lesion, suggestive of spinal epidural abscess from T10 to S1 (B). An axial image of L2 level demonstrates compression of spinal cord by a huge spinal epidural abscess (C). An axial image of L3 body level (D). B

• 

  Fig. 4. The enhanced T1 weighted coronal MR image demonstrates huge bilateral psoas abscesses with peripheral rim enhancement (A). Also, spinal epidural abscess and pyogenic spondylodiscitis L3-4 was observed. Axial images of L4 level (B) and L5 level (C).

• 

  Fig. 5. Two years after surgery, anteroposterior and lateral radiographs of lumbar spine demonstrate spontaneous fusion between L3 body and L4 body with mild collapse of L3 body.

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