Epidural Post - Trauma Abscess

Epidural abscess is a rare form of spinal infection, with serious complications and high mortality rate. Described by Morgagni in 1761, and defined as a clinical entity by Bergamaschi in 1820, epidural abscess had an invariably fatal evolution before the advent of antibiotics apud Browder and Meyers(1). The first person to suggest a surgical treatment was Barth (1901), to subsequently state that surgery alone could not modify disease evolution apud Walker(2). In 1925, Dandy reported a mortality rate of 83% in his case series apud Browder and Meyers(1). The combination of surgical manipulation and therapy with antibiotics reduced mortality rates to less than 50% of the cases until 1950(3), and improved diagnosis has reduced rates to less than 30%(4). The incidence of epidural abscess is 0.2 to 1.2 cases for each 10,000 hospitalizations, this number being higher in reference centers(5). In the last decade, there was a sudden raise on the number of cases, not only in immunodepressed and drug-addicted patients, but because of the increased number of diagnostic and therapeutic percutaneous procedures, and of the improved sensitivity of diagnostic studies, which frequently were unable to identify an epidural abscess(6). Despite of affecting people of all age groups, a higher number of patients in the sixth or seventh decade of life are affected, as well as a higher number of men (2:1)(7). Some clinical factors predispose to infections, such as diabetes mellitus, drug addiction, kidney failure, presence of neoplasia, obesity, prolonged therapy with corticosteroids, and sepsis. Local predisposing factors are recent traumas (7), spinal surgery, epidural injections or catheters. The most common etiologic agent is Staphylococcus aureus (70%), followed by Staphylococcus sp. (7%). In drug addicted individuals, a higher incidence of Gram-negative bacilli and pseudomonas is seen. In up to 40% of the cases, the infectious microorganism cannot be identified(6,8). This study intends to present an epidural abscess case secondary to spine fracture, in a patient having ankylosing spondylitis. CASE REPORT