Go Kubota1,2, Yasuchika Aoki3,4, Yusuke Sato1,5, Masashi Sato1,5, Satoshi Yoh1,5, Takayuki Nakajima1,6, Masahiro Inoue1,5, Hiroshi Takahashi7, Arata Nakajima8, Yawara Eguchi9, Sumihisa Orita9, Koichi Nakagawa8, Seiji Ohtori9. 1. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan. 2. Department of Orthopaedic Surgery, Kubota Orthopaedic Clinic, Katori, Chiba, Japan. 3. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan. yasuaoki35@fc4.so-net.ne.jp. 4. Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan. yasuaoki35@fc4.so-net.ne.jp. 5. Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan. 6. Department of Orthopaedic Surgery, Oyumino Central Hospital, Chiba-city, Chiba, Japan. 7. Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan. 8. Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan. 9. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.
Abstract
INTRODUCTION: Spondylodiscitis accompanying spinal epidural abscess is often treated with decompression surgery when there are neurological symptoms. We report a case of spondylodiscitis accompanying spinal epidural abscess with severe lower extremity pain that was successfully treated with percutaneous posterior pedicle screw fixation without decompression surgery. CASE PRESENTATION: A 53-year-old man was admitted to our hospital with severe low back pain (LBP), lower extremity pain and numbness, and fever. Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis at L2-L3 and a small epidural abscess located ventrally in the spinal canal. Initially, the patient was treated conservatively with empirical antibiotics. However, the lower extremity symptoms worsened and the epidural abscess expanded cranially to the T12 level. Percutaneous pedicle screw fixation without decompression was performed thirty-three days after admission. Postoperatively, the LBP and lower extremity pain dramatically improved. A postoperative MRI performed one week post-operatively showed an unexpectedly rapid decrease in the size of the epidural abscess, although no decompression surgery was performed. Two months after surgery, the epidural abscess completely disappeared. At the final follow-up (five years postoperatively), no recurrence of epidural abscess was observed, and the patient had no symptoms or disturbance of activities of daily living. DISCUSSION: This surgical strategy should be carefully selected for patients with spondylodiscitis with accompanying spinal epidural abscess who have lower extremity symptoms. The stabilising effect of pedicle screw fixation may be advantageous for controlling spinal infections. Percutaneous posterior pedicle screw fixation without decompression is an optional treatment for spondylodiscitis accompanying spinal epidural abscess.
INTRODUCTION: Spondylodiscitis accompanying spinal epidural abscess is often treated with decompression surgery when there are neurological symptoms. We report a case of spondylodiscitis accompanying spinal epidural abscess with severe lower extremity pain that was successfully treated with percutaneous posterior pedicle screw fixation without decompression surgery. CASE PRESENTATION: A 53-year-old man was admitted to our hospital with severe low back pain (LBP), lower extremity pain and numbness, and fever. Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis at L2-L3 and a small epidural abscess located ventrally in the spinal canal. Initially, the patient was treated conservatively with empirical antibiotics. However, the lower extremity symptoms worsened and the epidural abscess expanded cranially to the T12 level. Percutaneous pedicle screw fixation without decompression was performed thirty-three days after admission. Postoperatively, the LBP and lower extremity pain dramatically improved. A postoperative MRI performed one week post-operatively showed an unexpectedly rapid decrease in the size of the epidural abscess, although no decompression surgery was performed. Two months after surgery, the epidural abscess completely disappeared. At the final follow-up (five years postoperatively), no recurrence of epidural abscess was observed, and the patient had no symptoms or disturbance of activities of daily living. DISCUSSION: This surgical strategy should be carefully selected for patients with spondylodiscitis with accompanying spinal epidural abscess who have lower extremity symptoms. The stabilising effect of pedicle screw fixation may be advantageous for controlling spinal infections. Percutaneous posterior pedicle screw fixation without decompression is an optional treatment for spondylodiscitis accompanying spinal epidural abscess.
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