1141 - Atypical Presentation of Cervical Epidural Abscess Leading to Complicated Acute Rehab Course

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

RP

Ryan Palmer, DO

Resident Physician
UCF/HCA Physical Medicine & Rehabilitation Residency
Cantonment, Florida, United States

Co-Author(s)

CI

Chigozie Igbonagwam, DO

Resident Physician
UCF/HCA Physical Medicine & Rehabilitation Residency
Pensacola, Florida, United States
SB

Susan Belcher, MD

Program Director
UCF/HCA Physical Medicine & Rehabilitation Residency
Pensacola, Florida, United States

Submitter(s)

RP

Ryan Palmer, DO

UCF/HCA Physical Medicine & Rehabilitation Residency
Cantonment, Florida, United States

Case Diagnosis: Non-traumatic incomplete spinal cord injury C5-C8, cervical epidural abscess, discitis, osteomyelitis status post C5-C6 corpectomy and posterior cervical fusion C3-T1.

Case Description: 48-year-old female with history of depression, Lyme disease, renal cell carcinoma post left nephrectomy who developed acute onset quadriparesis and was found to have cervical cord compression and myelopathy secondary to C5-6 discitis/osteomyelitis and epidural abscess that was culture positive for ESBL E. Coli. Patient’s only known previous E. Coli infection was years prior, and during this acute infection she was incidentally found to have renal cell carcinoma and underwent immediate nephrectomy. After undergoing C5-6 corpectomy and posterior cervical C3-T1 fusion, the patient was admitted to inpatient rehab and underwent a complicated course requiring close monitoring and titrations of antibiotics, anti-spasmodics, and analgesics in the setting of solitary kidney and drug hypersensitivities.

Discussions: Spinal epidural abscess (SEA) is a rare but dangerous central nervous system infection. Cervical epidural abscess in particular is rare, accounting for less than one-third of overall SEA. Although they are less common, cervical epidural abscesses are associated with higher morbidity and mortality and worse functional neurological outcomes compared to thoracic and lumbar SEA. When SEA does occur, the most common pathogen is S. aureus with gram-negative bacilli such as E. coli only causing approximately 15% of SEA, typically after a UTI. 

Conclusions: This case involves a rare and serious acute infection with unique risk factors including prior E. coli infection and malignancy that led to a non-traumatic SCI. As well as a unique presentation, this patient also required specialized care in an acute rehab unit to ensure she received adequate dosages of medications that allowed her to maximally participate in rehab. This case could provide benefit to future learners pertaining to complex SCI diagnosis and care.