Surgical management of spinal epidural abscess: selection of approach based on MRI appearance

Spinal epidural abscess (SEA) is associated with considerable morbidity and mortality despite its infrequent occurrence. The evolution of magnetic resonance imaging has allowed for easier diagnosis of this potentially devastating condition. It is also possible to predict the intraoperative appearance of each individual case of SEA prior to the procedure, based on the MR findings. Surgical treatment of SEA usually involves extensive decompressive laminectomy, predisposing the patient to the development of spinal instability and deformity. Recent advances in surgical approach to SEA have seen the institution of less invasive techniques to manage this condition, including washout of the epidural space with catheters introduced via laminotomy. Our three cases illustrate the ability to predict the intraoperative findings in patients with SEA, and accordingly adjust the surgical approach to minimize the extensiveness of potentially destabilizing procedures, without impinging on the effectiveness of treatment.