Рентгенология & Радиология, 2019, LVIII 294-299

Primary spinal epidural abscesses

  1. Kitov, I. Kehayov, N. Traykova


Aim is to present the clinical course, diagnostic options and results of surgical treatment in patients with primary spinal epidural abscesses. During the period 2013–2017, three patients (2 women and 1 man) with primary spinal epidural abscesses were treated at the Neurosurgery Clinic at the University Hospital “St. George” EAD – Plovdiv, Bulgaria. The average age of the patients was 60 years. In all patients, the disease debuted with vertebralgia, with subsequent addition of pain and/or weakness of the limbs. The period from the onset of disease to hospitalization was 4, 7 and 25 days, respectively. During the admission, one patient did not have motor neurological deficits, while the other two patients had quadriparesis and paraplegia, respectively. The abscesses were located in the dorsal epidural space of the cervico-thoracic, thoracic and lumbar regions, with the affected segments being 5, 7 and 3, respectively. In all patients, an emergency decompressive laminectomy (before the 24th hour) was performed, and in one patient, it was combined with rear stabilization instrumentation. Two patients improved after the surgery and one died due to uncontrollable sepsis and multiple organ failure. The primary spinal epidural abscess is an acutely developing disease, leading to a pronounced neurological deficit in a short time. When suspected, it is imperative that magnetic resonance imaging be performed, which is the diagnostic tool of choice. The diagnosis must be followed by urgent surgical decompression of neural structures and evacuation of purulent collections.