Infectious Spondylodiscitis Accompanied by Widespread Thoracolumbar Subdural Abscess

Yu-Hun Jeong; Young Sang Lee; Sang-Jun Park

doi:10.4055/jkoa.2017.52.4.354

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Jeong, Lee, and Park: Infectious Spondylodiscitis Accompanied by Widespread Thoracolumbar Subdural Abscess

Original Article

J Korean Orthop Assoc 2017;52(4):354-358.

Published online: 1 December 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.4.354

Infectious Spondylodiscitis Accompanied by Widespread Thoracolumbar Subdural Abscess

Yu-Hun Jeong, M.D., Young Sang Lee, M.D., Sang-Jun Park, M.D.

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea

Correspondence to: Young Sang Lee, M.D. Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea TEL: +82-31-779-0175 FAX: +82-31-779-0179 E-mail: yslee2808@gmail.com

Received 5 October 2016 Revised 28 December 2016 Accepted 10 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Subdural abscess is relatively rare compared with epidural abscess, but it can rapidly progress to complete paraplegia with a poorer outcome. In particular, the occurrence of widespread subdural abscess is extremely rare. We experienced a case of widespread thoracolumbar subdural abscess with infectious spondylodiscitis in the thoracic spine. We report this rare case with a review of relevant literatures.

Keywords: spine, empyema, subdural

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Figure 1

Preoperative sagittal (A) and T8 level axial (C) T1-weighted contrast enhanced cervicothoracic magnetic resonance imaging (MRI) shows T5–6 disc space narrowing, endplate destruction, and epidural swelling with enhancement, suggesting infective spondylodiscitis. It also shows widespread thoracolumbar posterior subdural fluid collection with a rim enhancement, which suggest subdural emphyema. Preoperative sagittal (B) and L2 level axial (D) T1-weighted contrast enhanced lumbar MRI shows widespread thoracolumbar posterior subdural fluid collection with rim enhancement, suggesting subdural emphysema. It also shows clumping of the cauda equina with an enhancement of dural sac, suggesting arachnoiditis.

Figure 2

Postoperative sagittal (A), T8 level axial (B) T1-weighted contrast enhanced cervicothoracic magnetic resonance imaging showing subsequently evacuated subdural abscess, and the patient had no evidence of residual or recurrent spinal infection.

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