SPREADING EPIDURAL SPINAL SEPSIS CAUSING QUADRIPLEGIA SECONDARY TO STAPHYLOCOCCUS AUREUS – A SEVERE SPECTRUM OF SPINAL INFECTION DESPITE TREATMENT

Abstract

Spinal epidural sepsis is more widely recognised with MRI. Treatment includes antibiotics, multisystem support and drainage of pus. Neurological loss will often be stabilised but dramatic recovery is infrequent, explaining the importance of early intervention. This series highlights a very sinister spectrum of spinal infective disease despite ideal traditional treatment for spinal skeletal infection.

This is a retrospective case series review of five patients.

All patients presented with regional spinal pain, fever and regional musculoskeletal infective foci (e.g. discitis). Mild neurological abnormality existed in three patients. Rapid multisystem collapse occurred with the need for ventilatory support, despite institution of appropriate antibiotic treatment for all patients. All had grown Staphylococcus Aureus from blood cultures. Subsequent extensive quadriparesis/plegia developed, and repeat imaging demonstrated wide spread epidural pus in the cervical spine. Surgical treatment was considered but not performed when the prognosis was so poor neurologically and medically, and when the widespread epidural pus was so inaccessible. All patients died rapidly upon withdrawal of supportive treatment.

This paper describes a sinister spectrum of spinal infection with catastrophic complications despite “appropriate” treatment for previously diagnosed spinal foci infection. Positive blood cultures and fever alert to these dangers, and multisystem collapse heralded the development of cervical epidural infection. Possible interventions include early MRI scanning of the whole spine, more aggressive (than traditionally accepted) surgical treatment of infective foci in the spine in these circumstances, and minimally invasive cervical canal decompression procedures with multiple laminotomies.