Two case reports of cervical epidural abscess with progressive tetraplegia requiring surgical treatment

Abstract

Cervical epidural abscesses are relatively rare; cervical pain, fever, and neuropraxia are considered classic triads; however the series of symptoms is uncommon. When paralysis occurs, surgical treatment is required. Herein, we report two cases of cervical epidural abscesses that required surgical treatment. A 50-year-old man (Case 1) complained of cervical pain for 7 days. Magnetic resonance imaging (MRI) revealed a retropharyngeal abscess and an epidural abscess centered on C4/5. The patient was treated with cervical laminoplasty and drainage. Preoperative manual muscle testing (MMT) included 2/3 of upper limb proximal muscles, 1/1 of wrist dorsiflexion, and 2/3 of lower limb proximal muscles. Eventually, he was able to walk independently. Furthermore, a 53-year-old man (Case 2) complained of cervical pain for 7 days. He was hospitalized because of worsening neck pain and difficulty during movement. The day after admission, he complained of tetraplegia, and an MRI revealed discitis and epidural abscess centered on C5/6 and retropharyngeal abscess. He was referred to our hospital; on that same day, he was treated with cervical laminoplasty and drainage. Preoperative MMT was 2/3 in the proximal muscles of the upper extremity and 0/0 in the lower extremity beyond the iliopsoas muscle. Numbness in his upper limb remained, and his muscular strength was fully improved eventually. Posterior decompression was effective in both cases, and early surgical intervention resulted in an improvement in paralysis and infection control.