PMC6786417_01
Top: Neurological examination findings at the time of presentation. Bottom: Neurological presentation 24 h following admission showing complete quadriplegia
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Fig1
Council (MRC) grade 5 power in all four limbs with intact sensation and absent reflexes (Fig. 1). Complete blood profile including viral markers and blood cultures were sent for testing. Neurological examination was recorded using international standards for the neurological classification of spinal cord injury (Fig. 1).
Left: Pre-operative T2-weighted sagittal (left) and axial (right) magnetic resonance (MR) images show epidural spinal abscess (white arrows) extending from C1 (top row) to S5 (bottom row) with a pre-sacral abscess. Axial images show anteriorly pushed and compressed spinal cord. Right: One month post-operative T2-weighted sagittal (left) and axial (right) MR images show complete resolution of epidural abscess with a healthy looking cord and rim of cerebrospinal fluid (white arrows) around the cord suggesting adequate decompression
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Fig2
The MRI scan showed a hyperintense epidural collection extending from C2 to sacral neural foramina with peripheral post-contrast enhancement causing anterior displacement of the cord (Fig. 2). Repeat MRI at the end of 4 weeks of antibiotic therapy showed no residual epidural collection and adequately decompressed spinal canal (Fig. 2).
Schematic diagram depicting the physiological 'troughs' of the human spine (thick arrows: apex of cervical and lumbar lordosis), thin arrows in the epidural space depicting the direction of gravitation-assisted pooling of purulent material in the cervical and lumbar troughs in prone position, arrowheads depicting the planned laminectomy sites with feeding tubes inserted through these sites
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Fig3
A controlled suction was applied on the feeding tube using a 20 cm3 syringe (Figs. 3, 4). We also considered the gravity assisted pooling of epidural pus in the 'troughs' of the human spine in prone position, that is, apex of physiological lordosis of cervical and lumbar spine (Fig. 3).
Intraoperative images showing a proximal laminectomy site, b distal laminectomy site, c 20 ml syringe applying controlled pressure over suction tube, and d white coloured pus being evacuated using the feeding tube
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Fig4
A controlled suction was applied on the feeding tube using a 20 cm3 syringe (Figs. 3, 4).
Ten-month post-operative image of the Individual showing complete neurological recovery in bilateral upper and lower limbs
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Fig5
At the end of 10 months, the individual was re-evaluated and had normal motor and bowel and bladder function (Fig. 5).