Abstract
Objective: To report a complete neurological recovery following cervical laminectomy and drainage of an extradural panspinal abscess in a patient with quadriplegia~
Design: A retrospective case analysis
Subject: Case report – A 63 year-old male was admitted to the hospital fever of 102.5F and four days old neck and back pain. On admission he was drowsy and short of breath. He was treated successfully with intravenous Penicillin for proven Pneumococcal meningitis three weeks prior to this admissjon On examination he had respiratory distress and quadripegia and upgoing plantar reflex with a sensory level below T2. He had urinary incontinence but his anal tone was preserved with intact bulbocavernosus reflex. He was ventilated for five days. The CSF culture grew Streptococcus pneumoniae. Once his breathing became normal i. e. seven day later a MRI scan revealed a diffuse extradural abscess extending from the cranio-cervical junction to the lower thoracic region posteriorly There were associated oedema and ischemic changes in the cord. He underwent a cervical lamitomy and decompression from C3–7. The intra-operative findings were pus and granulation tissue in the epidural space. The pus was drained and the infected granulation tissue was removed. He was continued postoperatively on intravenous Benzyl Penicillin The patient showed signs of neurological recovery from the third day onwards.
Outcome measures: Ravicovitch and Spallone (1982)1 suggested a grading system to indicate the post-operative neurological outcome: 0-only signs of infection, 1-Root involvement, 2-Mild Spinal cord synptoms, 3-Severe spinal cord involvement, 4- Functional tresection.
Result: The patient was discharged three weeks following the surgery and was under a rehabilitation team. At six months follow-up he was walking without support and had MRC grade 5/5 power in both his upper and lower limbs. It has been recorded in literature that the duration of neurological symptoms has been shown to influence the functional outcome. If the neurologic grade 4 is present for more than 36 hours, little or no return of function could be expected. 2,3
Conclusion: This case is unique. The reasons are: 1) Pneumococcal extradural abscess are extremely rare, 2) Ahscess posterior to the cord is also very rare, 3) A full neurological recovery even though the decompression was performed seven days following the episode.
Abstracts prepared by Mr. A. J. Stirling, FRCS, and Miss A. Weaver. Correspondence should be addressed to Miss A. Weaver at the Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
BritSpine 2002, the second combined meeting of the British Association of Spinal Surgeons, the British Cervical Spine Society, The British Scoliosis Society and the Society for Back Pain Research, took place at the International Convention Centre in Birmingham UK between 27th February and 1st March 2002. The following presentations and posters were given and displayed.
References:
1 Ravicovitch MA, Spallone A: Spinal epidural abscesses: Surgical and parasurgical management. Eur Neurol21: 347–357,1982. Google Scholar
2 Simpson RK et al: Rapid onset of quadraplegia from a panspinal epidural abccess. Spine16(8): 1002–5, 1991. Google Scholar
3 Turner DP, Weston VC: Streptococcus pneumoniae spinal infection in Nottingham UK- a rare event. Clin Infect Dis28(4): 873–881. Google Scholar
