Spinal Epidural Abscess Following Administration of Epidural Steroid Injection for Low Backache – Need for Urgent Diagnosis and Intervention

Abstract

Background: Epidural steroid injection is an innocuous and efficient modality of treatment for chronic low back ache due to a multitude of causes, its use being on the rise in recent times. However, a note needs to be made regarding the potentially serious complications following epidural steroid injection including epidural space infection. This condition requires a high index of suspicion for early diagnosis and treatment. Case presentation: A 39-year-old lady presented, following a second episode of epidural steroid injection, with change in nature and increased severity of low back ache. Magnetic Resonance Imaging (MRI) of the lumbosacral spine showed a T1 hypointense, T2 hyperintense peripherally enhancing epidural collection at L3-L5 level for which she underwent laminectomy and evacuation of collection with complete relief of pain. Intraoperatively, there was a non-foul smelling, thick, yellowish pus which turned out to be positive for Staphylococcus aureus. Conclusion: Spinal epidural abscess is a rare complication following epidural steroid injection which requires a high degree of suspicion for early detection and treatment, to prevent permanent neurological sequela.