Spinal Subdural Empyema After a Dural Tear
Spinal subdural empyema is an exceptionally rare and serious condition. Immediate surgery with complete exposure and drainage of the abscess is generally recommended. The authors present a patient in whom a Staphylococcus aureus septicemia related to nosocomial pneumonia developed after a thoracic laminectomy. The surgery was further complicated by an unintended durotomy (dural tear). Ten days postoperatively, the patient experienced back pain and lower-extremity symptoms caused by a subdural empyema. Cultures from the wound also grew S. aureus. This represents the first case of spinal subdural empyema in which the spread of infection into the subdural space is believed to have been facilitated by a dural tear. The patient had a favorable outcome despite an initial delay in surgical intervention because of a pulmonary embolus.
Spinal subdural abscesses are very rare. As detailed in a review by Bartels, et al., the condition was first described in 1927, and since that time only slightly more than 50 cases have been reported. We present the first case, to our knowledge, in which an unintended durotomy (or dural tear) that occurred during a routine laminectomy may have contributed to the spread of systemic infection into the subdural space.
Spinal subdural empyema is an exceptionally rare and serious condition. Immediate surgery with complete exposure and drainage of the abscess is generally recommended. The authors present a patient in whom a Staphylococcus aureus septicemia related to nosocomial pneumonia developed after a thoracic laminectomy. The surgery was further complicated by an unintended durotomy (dural tear). Ten days postoperatively, the patient experienced back pain and lower-extremity symptoms caused by a subdural empyema. Cultures from the wound also grew S. aureus. This represents the first case of spinal subdural empyema in which the spread of infection into the subdural space is believed to have been facilitated by a dural tear. The patient had a favorable outcome despite an initial delay in surgical intervention because of a pulmonary embolus.
Spinal subdural abscesses are very rare. As detailed in a review by Bartels, et al., the condition was first described in 1927, and since that time only slightly more than 50 cases have been reported. We present the first case, to our knowledge, in which an unintended durotomy (or dural tear) that occurred during a routine laminectomy may have contributed to the spread of systemic infection into the subdural space.
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