Complete Spinal Cord Injury Secondary to Serratia marcescens Spinal Epidural Abscess: A Report of Significant Neurological Improvement After a Delayed Presentation

Cureus, 2023 · DOI: 10.7759/cureus.44451 · Published: August 31, 2023

Simple Explanation

This case report describes a patient with a complete spinal cord injury (SCI) who showed significant neurological improvement after delayed medical and surgical intervention. The patient, who had a four-week history of complete SCI, improved from ASIA A to C after antibiotic treatment and surgical decompression. This outcome challenges the traditional belief that delayed intervention in complete SCI cases has minimal impact on neurological recovery.

Study Duration

Not specified

Participants

One 55-year-old incarcerated male

Evidence Level

Not specified

Key Findings

1
A patient with a complete SCI (ASIA A) of over four weeks duration improved two ASIA grades after antibiotic treatment and surgical decompression.
2
The patient's blood cultures grew Serratia marcescens, a rare cause of spinal epidural abscess, likely due to intravenous drug use.
3
The patient recovered from an ASIA A to C by discharge after medical and surgical intervention.

Research Summary

The case report discusses a 55-year-old male with a complete SCI secondary to a Serratia marcescens spinal epidural abscess (SEA). Despite a delayed presentation and initial decision for medical management, the patient showed unexpected neurological improvement after antibiotic treatment and surgical decompression. The patient's recovery from ASIA A to C challenges the traditional view that delayed intervention in complete SCI cases has limited benefit.

Practical Implications

Aggressive Approach to Complete SCI

This case supports a more aggressive approach to those with complete spinal cord injuries, even with prolonged neurological deficits.

Consideration of Surgical Intervention

Surgical intervention should be considered even in delayed presentations of complete SCI, especially when there are signs of improvement with medical management.

Importance of Identifying Infection Source

Identifying the source of infection, such as IVDU, is crucial in tailoring the treatment approach and understanding potential outcomes.

Study Limitations

1
Single case report limits generalizability
2
Patient did not return for follow-up visits, limiting long-term outcome assessment
3
Lack of a control group

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