Obrador GT, Levenson DJ
Spinal epidural abscess in hemodialysis patients: report of
three cases and review of the literature
Am J Kidney Dis
(Jan) 27:75-83 1996

Spinal epidural abscess is a rare but serious neurological complication in
hemodialysis patients.
Obrador and Levenson describe 3 patients and review 9 additional cases in
detail from other series. Most such cases are related to S. aureus
infection from either the graft or an infected skin ulcer. Presenting
complaints are fever, backache, local spinal tenderness, leg pain and
weakness, sphincter dysfunction, paresis and/or paralysis. MRI appears to be
less sensitive (80%) than computed tomography-myelography. Plain CT scanning
without myelography has low sensitivity and can give misleading results
(e.g., disc protrusion).
Of the 12 patients reviewed, one died and eight had severe neurologic
deficits, including two with paralysis. Early (immediate) decompressive
surgery usually is advised, although rare patients can be treated with
antibiotics only. (John T. Daugirdas, M.D., Univ. of IL at Chicago)