• The Korean Journal of Pain
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• 제9권1호
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• pp.275-278
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• 1996

The placement of epidural catheter may cause complications such as epidural hematoma, epidural abscess and neural damage. Among the above complications, epidural abscess is a rare but serious complication. This report pertains to a diabetic metlitus patient who developed spinal epidural and subdural abscess after continuous epidural catheterization for management of pain caused by reflex sympathetic dystrophy. The patient experienced urinary incontinence, as a neurologic sign, 8 days after epidural catherization. In was considered that the poor prognosis was due to a combination effects of a delayed visit to the hospital for treatment, rapid progression of abscess and uncontrolled blood sugar level. We therefore recommend aseptic technique and proper control of blood sugar level to prevent infection during and after epidural catheterization for diabetic patients. Early diagnosis of epidural abscess following surgical procedure must be required to avoid sequelae.

• The Korean Journal of Pain
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• 제19권2호
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• pp.266-270
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• 2006

A case of an epidural abscess, a rare but possibly devastating complication of epidural instrumentation and catheterization, which occurred in a cancer pain patient with an epidural port connected to the epidural catheter, is described. Although cases of a catheter related epidural abscess have been intermittently reported, those following epidural port implantation are very rare, with no case having been reported in Korea. Herein, the case of a 31-year-old man, who developed an epidural abscess 54 days after subcutaneous implantation of an epidural port connected to an epidural catheter, is reported. Methicillin-sensitive staphylococcus aureus was detected in a culture of the purulent discharge. Magnetic resonance imaging was essential, not only for the diagnosis of the epidural abscess, but also for determining the extent of spread. The patient refused further evaluation and treatment, and expired 22 days later.

• The Korean Journal of Pain
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• 제9권2호
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• pp.434-438
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• 1996

Epidural abscess is associated with placement of epidural catheter is very rare. We experienced two cases of epidural abscess formation after placement of epidural catheter for pain management. A 63 years old female patient received thoracic epidural catheterization for management of pain due to herpes zoster on right T4 dermatome. Two weeks after catheterization, she complained of paraparesis and anesthesia below $T_4$ dermatome. Four weeks later magnetic resonance images was performed and revealed epidural abscess on $T_2-T_5$. Emergent decompressive laminectomy was performed but neurologic symptoms were not improved. In other case, a 75 years old male patient received lumbar epidural catheterization for management of Buerger's disease. About on month later, pus was aspirated from lumbar epidural space. But further evaluation could not be achieved because he wanted to discharge against advice. We emphasize that epidural abscess results sequele serious and prompt diagnosis and treatment is important.

• The Korean Journal of Pain
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• 제2권1호
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• pp.94-96
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• 1989

경막외 농양의 항생이 경막외 카테타 거치로 인한 것은 드물고 다른 감염증과 골수염의 혈행성 전파로 기인된 것이 대부분이며 원인군은 황색 포도상구균이 가장 많다. 농양 발생시 환자는 농양형성 부위의 통증과 압통, 고열, 하지마비 등의 증상을 나타내게되며 척수조영술이나 전산화 단층촬영 등으로 진단이 가능하며 항생제의 투여와 추궁절제술을 시행하여 농양으로 인한 척수압박을 해소하는 동시에 배농시키는 등의 적극적 치료를 시행하여야 한다. 본 환자는 고령으로 인한 면역능력의 저하와 어울려 카테타 관리 및 약물 주입시의 감염으로 인하여 경막의 농양이 발생하였으나 전신적인 항생제 투여만으로 잘 치유된 경우이다. 이와 같은 합병증을 예방하기 위해서는 경막외 천자시 뿐만 아니라 카테타 거치 후의 카테타 관리 및 카테타를 통한 약물 주입시에도 무균 조작을 철저히 해야할 것이다.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1074-1079
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• 2000

We report a case of pyogenic spondylitis on L2 and L3 with diffuse epidural abscess up to T4 to L3 and large psoas abscess. A forty-nine-year old male was presented with progressive back pain, left flank pain and ab-dominal distention, weakness of the both legs and voiding and defecation difficulty during last 2 months. Initially multiple coronal hemilaminectomies from T4 to T12 were done for the treatment of diffuse thoracic epidural ab-scess. Then second operation via left retroperitoneal approach was performed for lumbar spondylitis and psoas abscess on third day after initial operation. After removal and curettage of pyogenic psoas and epidural abscess and spondylitis (L2-L3), iliac bone grafting with Keneda instrumentation from L1 to L4 was done simultaneously. Postoperative course has been unevenful without recurrent infection. The literature on diffuse epidural and large psoas abscess with pyogenic spondylitis are reviewed and instrumentation for stabilization of pyogenic spondylitis is also discussed.

• The Korean Journal of Pain
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• 제11권1호
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• pp.165-168
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• 1998

Although the incidence of epidural abscess is low, patient requiring continuous epidural analgesia for control of acute and chronic pain is increasing rapidly. Therefore we anticipate more frequent encounters with epidural abscess patients in future. Once epidural abscess formation begins, early diagnosis and treatment is very important to prevent permanent neurologic damage. The authors encountered a case of epidural abscess after continuous epidural analgesia for control of perineal pain due to rectal cancer. Forty-eight hours after the block, patient began to suffer severe low back pain, local tenderness, and fever. So the catheter was removed and culture sensitivity test was done with blood and local drainage. The test results identified methicillin susceptible staphylococcus aureus. Antibiotics were administered. Ten days after the block, left ankle jerk disappeared, and force of dorsiflexion of great toe decreased, but numbness or anesthesia appeared at $L_5$ dermatome. Laminectomy was performed, and abscess and necrotic fat material was removed from left $L_5$ nerve root. The patient was discharged 12 days after operation without any neurologic sequalae.

• The Korean Journal of Pain
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• 제18권2호
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• pp.235-239
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• 2005

Although the incidence of epidural abscess is rare, once it occurs, its high morbidity rate and high mortality rate create a great deal of serious sequalae for these patient, if this condition is not diagnosed in time. We experienced a case of epidural abscess after performing percutaneous vertebroplasty in a patient who had a lumbar spinal compression fracture. This case will remind the pain clinician of the possibility of epidural abscess after such a procedure.

• The Korean Journal of Pain
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• 제9권1호
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• pp.279-282
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• 1996

A 45-year-old male received cervical continuous epidural block for posterior neck pain radiating to right upper extremity secondary to cervical herniated nucleus pulposus. Three days after epidural catheterization, fever, radicular pain and weakness of both upper extremities were developed. On admission, his temperature was $38.3^{\circ}C$ and showed progressive weakness and numbness in both upper and lower extremities. Cervical epidural abscess was suspected; MRI showed an epidural abscess from C4 to C7 level. Within 24 hours of admission, surgical decompression and drainage was effected. Culture of pus obtained at the lesion yielded Staphylococcus aureus. He was treated with intravenous antibiotics for 7 weeks resulting marked improvement of neurologic signs and symptoms.

• The Korean Journal of Pain
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• 제9권2호
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• pp.430-433
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• 1996

It is common practice to use epidural catheter for anesthesia or for postoperative analgesia and other kinds of pain control. However, Intraspinal infection associated with this practice is rare event. We report a case of spinal subdural abscess occuring in patient who had recently received epidural catheterization. The cause in this case is not certain, although infection from the epidural catheter is the best possibility. We recommand an aseptic technique in all procedure for epidural or spinal analgesia.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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• pp.37-40
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• 2008

Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by facultative intracellular bacteria of the genus Brucella, which can involve multiple organs and tissues. We report an uncommon case of spondylodiscitis with epidural abscess due to Brucella in a male stockbreeder. Diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Clinical and radiological improvement were observed with a combined antimicrobial therapy of doxycycline, rifampicin, and gentamycin.