Acta Neurochirurgica

, Volume 150, Issue 4, pp 381–386 | Cite as

Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess

Short Illustrated Review


Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate.

A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9–10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete.

Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

Keywords: Spinal infection; surgical treatment; pyogenic spondylodiscitis; epidural abscess; paraplegia. 


  1. Butler, JS, Shelly, MJ, Timlin, M, Powderly, WG, O’Byrne, JM 2006Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral centerSpine3126952700PubMedCrossRefGoogle Scholar
  2. Chen, WH, Jiang, LS, Dail, LY 2007Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentationEur Spine J1613071316PubMedCrossRefGoogle Scholar
  3. Derkinderen, P, Duval, X, Bruneel, F, Laissy, JP, Regnier, B 1998Intramedullary spinal cord abscess associated with cervical spondylodiskitis and epidural abscessScand J Infect Dis30618619PubMedCrossRefGoogle Scholar
  4. Emery, SE, Chan, DP, Woodward, HR 1989Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone graftingSpine14284291PubMedGoogle Scholar
  5. Finsterer, J, Mahr, K, Volker Paral, V 2003Favorable outcome of long-lasting thoracic spondylodiscitis with spinal epidural abscess induced by Staphylococcus aureusSouth Med J967073PubMedCrossRefGoogle Scholar
  6. Hadjipavlou, AG, Mader, JT, Necessary, JT, Muffoletto, AJ 2000Hematogenous pyogenic spinal infections and their surgical managementSpine2516681679PubMedCrossRefGoogle Scholar
  7. Jinkins, JR 2002Magnetic resonance imaging of spinal infectious disease: pathophysiologic concepts of origin and spreadActa Clin Croat412930Google Scholar
  8. Kapeller, P, Fazekas, F, Krametter, D, Koch, M, Roob, G, Schmidt, R, Offenbacher, H 1997Pyogenic infectious spondylitis: clinical, laboratory and MRI featuresEur Neurol389498PubMedCrossRefGoogle Scholar
  9. Khanna, RK, Malik, GM, Rock, JP, Rosenblum, ML 1996Spinal epidural abscess: evaluation of factors influencing outcomeNeurosurgery39958964PubMedCrossRefGoogle Scholar
  10. Korovessis, P, Sidiropoulos, P, Piperos, G, Karagiannis, A 1993Spinal epidural abscess complicated closed vertebral fracture: a case report and review of literatureSpine18671674PubMedCrossRefGoogle Scholar
  11. Kowalski, TJ, Berbari, EF, Huddleston, PM, Steckelberg, JM, Osmon, DR 2006Do follow-up imaging examinations provide useful prognostic information in patients with spine infectionClin Infect Dis43172179PubMedCrossRefGoogle Scholar
  12. Kuker, W, Mull, M, Mayfrank, L, Topper, R, Thron, A 1997Epidural spinal infection: variability of clinical and magnetic resonance imaging findingsSpine22544551PubMedCrossRefGoogle Scholar
  13. Mackenzie, AR, Laing, RB, Smith, CC, Kaar, GF, Smith, FW 1998Spinal epidural abscess: the importance of early diagnosis and treatmentJ Neurol Neurosurg Psychiatry65209212PubMedGoogle Scholar
  14. Maiuri, F, Iaconetta, G, Gallicchio, B, Manto, A, Briganti, F 1997Spondylodiscitis: clinical and magnetic resonance diagnosisSpine2217411746PubMedCrossRefGoogle Scholar
  15. Mann, S, Schutze, M, Sola, S, Piek, J 2004Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patientsNeurosurg Focus17E3PubMedCrossRefGoogle Scholar
  16. Nather, A, David, V, Hee, HT, Thambiah, J 2005Pyogenic vertebral osteomyelitis: a review of 14 casesJ Orthop Surg (Hong Kong)13240244Google Scholar
  17. Numaguchi, Y, Rigamonti, D, Rothman, MI, Sato, S, Mihara, F, Sadato, N 1993Spinal epidural abscess: evaluation with gadolinium-enhanced MR imagingRadiographics13545560PubMedGoogle Scholar
  18. Saban, KL, Ghaly, RF 1998Spinal cervical infection: a case report and current updateJ Neurosci Nurs30105109PubMedGoogle Scholar
  19. Stevens, OEJ, Seibly, JM, Chen, YH, Dickerman, RD, Noel, J, Kattner, KA 2007Reactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years. Case reportJ Clin Neurosci14585589PubMedCrossRefGoogle Scholar
  20. Van de Warrenburg, BP, Wesseling, P, Leyten, QH, Boerman, RH 2004Myelopathy due to spinal epidural abscess without cord compression: a diagnostic pitfallClin Neuropathol23102106PubMedGoogle Scholar
  21. Woertgen, C, Rothoerl, RD, Engelert, C, Neumann, C 2006Pyogenic spinal infections and outcome according to the 36-item short form health surveyNeurosurg Spine4441446CrossRefGoogle Scholar
  22. Yen, HL, Kong, KH, Chan, W 1998Infectious disease of the spine: outcome of rehabilitationSpinal Cord36507513PubMedCrossRefGoogle Scholar
  23. Young, WF, Weaver, M, Snyder, B, Narayan, R 2001Reversal of tetraplegia in patients with cervical osteomyelitis-epidural abscess using anterior debridement and fusionSpinal Cord39538540PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of NeurosurgeryAdnan Menderes University HospitalAydınTurkey

Personalised recommendations