Long-segment cervical brucellar epidural abscess limited by a disc barrier presenting with tetraparesis: A case report

Spinal epidural abscess caused by Brucella species is an uncommon but potentially devastating complication of osteoarticular brucellosis. Cervical involvement is exceedingly rare, and long-segment cervical brucellar epidural abscess presenting with tetraparesis represents an uncommonly described clinical scenario. A 42-year-old female presented with a two-week history of progressive tetraparesis. Neurological examination revealed MRC grade 3/5 weakness in the upper extremities and 4/5 in the lower extremities, with bilateral sensory disturbance and upper motor neuron signs, classified as ASIA grade D. Gadolinium-enhanced MRI demonstrated a long-segment anterior epidural collection from C2 to C6 with significant spinal cord compression, associated with contrast enhancement of the C5-6 disc space consistent with spondylodiscitis. Laboratory investigations revealed ESR 68 mm/h, CRP 48 mg/L, WBC 11.2 00d7 1000b3/03bcL, and Brucella standard tube agglutination titre of 1/320. Blood cultures were negative. The patient underwent three-level anterior cervical microdiscectomy (C3-4, C5-6, and C6-7) with complete evacuation of the epidural abscess and intraoperative rifampicin irrigation. Intraoperative cultures confirmed Brucella melitensis. Targeted antimicrobial therapy consisted of doxycycline 100 mg twice daily combined with rifampicin 600 mg once daily for 12 weeks. Neurological recovery was substantial; lower extremity strength normalised to 5/5 at one month and upper extremity strength at three months. At 12-month follow-up, complete neurological recovery was confirmed with no evidence of recurrence on MRI. This case raises the hypothesis that a pathological intervertebral disc may act as an anatomical barrier limiting caudal spread of epidural infection, warranting further investigation.