Epidural Abscess During a Spinal Cord Stimulator Trial: A Case Report

Abstract

Background: Spinal cord stimulation (SCS) can be beneficial for low back and radicular pain. A short trial of SCS evaluates the potential effectiveness of this therapy for a specific patient, while also decreasing the likelihood of a failed permanent implant. While rare, an epidural abscess is difficult to diagnose based on its nonspecific and unreliable clinical presentation. Case: We present a case of an acute-onset methicillin-sensitive Staphylococcus aureus epidural abscess 72 to 96 hours into a trial of a percutaneous spinal cord stimulator. The patient had no prior medical history of an immunocompromised state or other significant risk factors. Discussion: An epidural abscess can rapidly arise from an SCS trial despite strict aseptic technique and prophylactic pre-procedural antibiotics. Spinal epidural abscesses are being detected earlier, and an increasing number of patients are being managed medically. However, it may be challenging to differentiate focal back pain from acute or chronic pain, expected post-procedural pain, and a new entity such as an abscess.