1130 - Management and Rehabilitation of Incomplete Spinal Cord Injury Secondary to Thoracic Epidural Abscess Following Spinal Cord Stimulator Implantation: A Case Report

Spinal cord stimulators (SCS) are commonly used to manage intractable low back and lower extremity pain. Although overall infection risk has decreased to 2.4–3.1% as reviewed by Koushik et al., serious complications such as epidural abscesses can result in concomitant spinal cord injury (SCI). We describe a rare case of incomplete SCI secondary to thoracic epidural abscess following SCS implantation.

Case Description:

A 71-year-old male with an SCS for lumbar stenosis presented 15 months after implantation with new-onset urinary incontinence, saddle anesthesia, decreased lower extremity sensation, and inability to ambulate. MRI demonstrated an epidural abscess extending from T7 to T10 with severe cord compression from T8 to T11.

Discussions:

The patient underwent thoracic laminectomy with decompression, SCS explantation, and incision and drainage of the abscess. Cultures grew methicillin-resistant Staphylococcus aureus, and he received intravenous antibiotics. His ASIA exam was significant for T6 AIS C. Following surgery, he was admitted to an acute rehabilitation facility for ongoing medical and functional recovery. During a 14-day inpatient rehabilitation course, the patient demonstrated a 19–20% improvement in self-care and mobility domains, consistent with expected recovery trajectories in incomplete SCI.

Conclusions:

Although rare, SCI secondary to epidural abscess remains a potential complication of SCS. While most infections occur within six weeks post-implantation, clinicians must maintain vigilance at any time patients develop new bladder or bowel dysfunction, neurologic weakness, gait imbalance, or altered sensation. Prompt spinal MRI and surgical management are essential to reduce morbidity and optimize outcomes.