Adithi Vemuri, D.O.
Resident Physician, PGY-3
Northwestern Medicine Marianjoy Rehabilitation
Lombard, Illinois, United States
Anita Kou, MD
Attending Physician
Northwestern Medicine Marianjoy Rehabilitation Hospital
Wheaton, Illinois, United States
A 54 year-old-male presented to AIR after a C5 corpectomy/C5/6 cage placement, C3-7 plating for ventral epidural abscess evacuation caused by MRSA bacteremia and C3-6 PSIF following a ground-level fall due to new weakness and decreased sensation in all four extremities.
Case Description: In 2022, our patient presented to a dentist for an oral-nasal fistula repair after multiple sinus infections. The patient was scheduled for a buccal flap closure however was unable to follow through with the surgery. In 2023 he had a few hospitalizations following falls. Imaging continued to reveal mucosal thickening of nasal passages however no abscess was seen. In 2024 he presented with bilateral lower extremity weakness/decreased sensation. A cervical epidural abscess was diagnosed and treated with IV antibiotics. Initial ISNCSCI exam was a C3 AIS C incomplete tetraplegia. Physical exam 1-2/5 strength in the bilateral lower extremities/MAS 1 noted in RLE. He was total assist for transfers/ADLs, wheeling a manual wheelchair < 50 ft, and showed decreased memory/mild-moderate cognitive deficits.
Discussions: There is a tremendous amount of literature reviewing diagnostics/treatment for cervical epidural abscess. There are few cases that delineate the functional gains made after a 2-3 week stay in AIR.. A retrospective analysis in 2008 examined infection related SCI patient outcomes, however this study included mostly thoracic epidural abscess and paraplegic cases. Moreover, this study evaluated overall FIM scores rather than specific improvements in each patient’s therapies.
Conclusions: Our study highlights the importance of AIR for patients with cervical epidural abscesses causing tetraplegia. It is unlikely considering our patient’s medical complexity that in another setting he would have made such immense functional gains. The functional gains that our patient made with the use of assisted devices and multidisciplinary therapies demonstrates the necessity of AIR in patients with cervical epidural abscesses causing tetraplegia.
