Panayotis Jusakos, MD
PMR Resident
One Brooklyn Health
orlando, Florida, United States
Alvin H. Wang, B.S. (he/him/his)
Medical Student
Touro University California College of Osteopathic Medicine
Vallejo, California, United States
Ajit Kohli, D.O.
Resident Physician
SUNY Downstate University
Brooklyn, New York, United States
Charlene Canales, DO
Resident Physician
One Brooklyn Health
Woodside, New York, United States
Michael Sposito, MD
Resident Physician
One Brooklyn Health
Brooklyn, New York, United States
Daniel Sanchez, MD
PM&R Resident
One Brooklyn Health/Kingsbrook Jewish Medical Center
Woodbridge, California, United States
Marc K. Ross, MD
Chair, Department of Rehabilitation Medicine
OB001
Brooklyn, New York, United States
A 57-year-old male with history of hypertension, diabetes, and obesity initially presented with lower back pain and bilateral leg numbness. CT imaging identified large disc herniation at T11-T12. Patient underwent multilevel laminectomy and decompression at T11-T12. Postoperatively, he developed a urinary tract infection and a sacral wound ulcer. He was admitted to an acute rehabilitation facility but exhibited no functional improvement and experienced progressive lower extremity weakness. MRI was done and confirmed the presence of an epidural abscess at T10-T12. The patient was transferred for neurosurgical intervention, and the epidural abscess was surgically drained.
Discussions:
The patient's lack of progress in rehabilitation, coupled with worsening neurological function, underscores the importance of maintaining a high index of suspicion for postoperative complications such as epidural abscesses. While the initial focus may be on rehabilitation in cases of post-laminectomy debility, clinicians must remain vigilant for alternative causes of functional decline, especially when the patient fails to respond to therapy as expected. The presence of an epidural abscess can significantly worsen spinal cord compression, leading to further neurological deterioration, as seen in this case. Early recognition through clinical vigilance and appropriate imaging studies is essential to prevent permanent deficits. This case emphasizes that persistent or worsening symptoms in post-laminectomy period should prompt re-evaluation. Delays in diagnosis and treatment of epidural abscesses can lead to severe and irreversible neurological damage.
Conclusions:
Clinicians must maintain a high level of suspicion for complications like epidural abscesses in post-laminectomy patients who exhibit unexpected deterioration during rehabilitation. Timely imaging and intervention are critical to identifying and addressing epidural abscesses early, thereby preventing further neurological decline and optimizing patient outcomes. Ensuring that such complications are promptly managed not only enhances the effectiveness of rehabilitation but also mitigates the risk of long-term disability.
