Disclosures: Nathaniel V. Zuziak, DO: Nothing to disclose

Case Description: The patient, without recent history of trauma, infection, surgery, or drug use, presented to the ED with body aches, fever, and paresthesias in her right toes. Despite a negative work up, symptoms worsened at home with lumbago, lower extremity weakness, numbness, fever and urinary retention. A thoracic spine MRI showed a posterior epidural collection from T2-4 with cord compression. She underwent T1-4 decompression with drainage of the fluid collection. Pathology revealed fragments of purulent exudate but resulted in negative cultures. Given her lack of predisposing factors for spinal epidural abscess (SEA), she was diagnosed with SSEA resulting in thoracic myelopathy with paraplegia. Based on the American Spinal Injury Association Impairment Scale (AIS), she was classified as T1 AIS D spinal cord injury. The patient was admitted to acute inpatient rehab where she participated in physical and occupational therapy over the course of 37 days.

Setting: Inpatient rehabilitation facility

Patient: 60-year-old female with spontaneous spinal epidural abscess (SSEA) .

Assessment/Results: Initially, she was nonambulatory, required moderate assistance for bed mobility, and max assistance for pivot transfers. Her overall Functional Independence Measure (FIM) score was 59. At discharge, bed mobility and transfers were contact guard, and she ambulated with minimum assistance, 150 feet using a rolling walker. She also improved to a T3 AIS D with FIM score of 91.

Discussion: SSEAs are rare with an incidence of 0.88 cases per 100,000 hospital admissions per year, with virtually no studies discussing rehabilitation outcomes. This is the first case report known to us highlighting the rehabilitation course of a patient with SSEA.

Conclusion: Early acute rehabilitation for SSEAs may have significant potential for neurologic improvement. Though rare, the neurologic deficits of SSEAs can be devastating, warranting more research on rehabilitation treatments and outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-myelopathy-with-paraplegia-secondary-to-spontaneous-spinal-epidural-abscess-a-case-study-focusing-on-rehabilitation-outcomes/