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Inappropriate medical management of spinal epidural abscess
  1. P Harringtona,
  2. P A Millnera,
  3. D Vealeb
  1. aSpinal Surgery Unit, St James's University Hospital, Leeds, UK, bDepartment of Rheumatology, Leeds General Infirmary, Leeds, UK
  1. Mr P Harrington, 119 Castle Road, Hull HU16 5JF, UKHarrington{at}


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.

  • spine
  • paraparesis
  • rheumatoid disease
  • back pain
  • lumbar spine

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