Concomitant epidural and subdural spinal abscess: a case report

BACKGROUND CONTEXT: Spinal subdural abscess (SSA) is a rare occurrence for which the management typically involves open surgical removal and washout. PURPOSE: This case report aims to review the literature and discuss the management of patients with SSA. STUDY DESIGN: We present a case of a 33-year-old female who presented with a spinal epidural abscess and concurrent SSA. She presented in the context of intravenous (IV) drug use, back pain, and generalized lower extremity weakness. METHODS: The literature was reviewed with a focus on modern treatment options for SSA. Our patient was managed with IV antibiotics, and separate laminectomies and washouts for both lesions. RESULTS: The patient recovered well with return of neurologic function and normalization of infection markers. The review of the literature resulted in a management flowchart that will help direct treatment of SSA. CONCLUSIONS: The literature suggests that in a patient with a definitive diagnosis of SSA, limited surgical management and IV antibiotics are the mainstay of treatment in a patient with a decline in neurologic function. There may be a role for expectant management in the absence of diagnostic imaging or the neurologically stable patient. (C) 2015 Elsevier Inc. All rights reserved.