A Good Short-term Outcome in Delayed Decompression of Cauda Equina Syndrome in Klebsiella pneumoniae Spinal Epidural Abscess: A Case Report
- Author:
Hanifah J, MBBCh (Ain Shams), Joehaimey J, MMed Orth (USM), Yusof MI, MMed Orth (USM)
- Publication Type:Case Report
- Keywords:
spinal epidural abscess, klebsiella pneumoniae, cauda equina syndrome, delayed decompression
- From:Malaysian Orthopaedic Journal
2017;11(2):85-88
- CountryMalaysia
- Language:English
-
Abstract:
Spinal epidural abscess is a severe, generally pyogenic,
infection of the epidural space of spinal cord or cauda
equina. The swelling caused by the abscess leads to
compression or vascular disruption of neurological
structures that requires urgent surgical decompression to
avoid significant permanent disability. We share a rare case
of Klebsiella pneumoniae spinal epidural abscess secondary
to haematogenous spread of previous lung infection that
presented late at our centre with cauda equina syndrome that
showed good short-term outcome in delayed decompression.
A 50-year old female presented with one-week history of
persistent low back pain with progressively worsening
bilateral lower limb weakness for seven days and urinary
retention associated with saddle anesthesia of 2-day
duration. Magnetic resonance imaging with contrast of the
lumbo-sacral region showed an intramuscular collection of
abscess at left gluteus maximus and left multifidus muscle
with a L3-L5 posteriorly placed extradural lesion enhancing
peripherally on contrast, suggestive of epidural abscess that
compressed the cauda equina. The pus was drained using the
posterior lumbar approach. Tissue and pus culture revealed
Klebsiella pneumoniae, suggestive of bacterial infection.
The patient made immediate improvement of muscle power
over bilateral lower limbs postoperative followed by ability
to control micturition and defecation the 4th post-operative
day. A good short-term outcome in delayed decompression
of cauda equine syndrome is extremely rare. Aggressive
surgical decompression combined with antibiotic therapy led
to good short-term outcome in this patient despite delayed
decompression of more than 48 hours.
