Extended report
Inappropriate medical management of spinal epidural abscess
P Harringtona, P A Millnera, D Vealeb
a Spinal Surgery Unit,
St James's University Hospital, Leeds, UK, b Department of Rheumatology,
Leeds General Infirmary, Leeds, UK
Correspondence to: Mr P Harrington, 119 Castle Road, Hull HU16 5JF, UK Harrington{at}aol.com
Accepted for publication 28 July 2000
A 67 year old man with longstanding rheumatoid disease was
referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar
spine. Ten months previously, he had started antibiotic treatment at
another hospital for an epidural abscess arising at the level of the
L2-3 disc space. Despite completing seven months of medical treatment
with appropriate antibiotics, he had a recrudescence of acute back pain
shortly after restarting methotrexate treatment. Urgent anterior spinal
decompression with excision of the necrotic vertebral bodies of L1-3
was performed. The indications for the surgical management of spinal
epidural abscess are reviewed.
© 2001 by Annals of the Rheumatic Diseases
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