Not So Innocent Procedure: A Spinal Epidural Abscess Following Acupuncture—A Case Report and Literature Review of the Past 28 Years

Background Spinal epidural abscess is a rare but potentially devastating infection that may cause irreversible neurological injury. Although acupuncture is generally considered safe, serious infectious complications have been reported. Case A previously healthy 54-year-old woman developed neck pain, diffuse paresthesia, and urinary retention 10 days after acupuncture. Magnetic resonance imaging revealed a posterior epidural abscess from C5 to T2 with severe spinal cord compression, together with paravertebral and retropharyngeal abscesses. Within 36 hours, her neurological status deteriorated, progressing to quadriparesis with minimal motor function in all 4 limbs. An urgent decompression and abscess evacuation was performed. Blood and intraoperative cultures grew penicillin-sensitive Staphylococcus aureus. Repeat imaging showed an anterior epidural abscess with C5 to C6 discitis-osteomyelitis, requiring a second anterior decompression and fixation. Literature Review A review of the published literature revealed 22 reported cases of spinal epidural abscess following acupuncture. Patients ranged from 12 to 89 years old; symptoms typically developed within 2 weeks. S aureus was the predominant pathogen, and 59.1% required surgery. Conclusion Although acupuncture is generally safe, in rare cases, it may lead to severe spinal infection. Early diagnosis and prompt treatment are essential to prevent neurological sequelae.