Spinal surgery: an unusual case of spinal epidural abscess

Southeast Missouri Hospital in Cape Girardeau, Missouri, admitted a patient from an outside hospital with back pain and progressive quadriparesis. Imaging revealed an extensive spinal epidural abscess that extended from the craniocervical junction to the sacral spine. Because of the patient's critical condition and the need to minimize the duration of surgery and anesthesia, two surgical teams simultaneously operated on the patient on the day of admission. One team performed a decompressive laminectomy of C1 through C7 and T1 through T6, while the other team performed, through a separate skin incision, a decompressive laminectomy on T11, L2, L3, and L4 as well as partial evacuation of a psoas abscess. The extensive laminectomies were required due to the adherent granulomatous nature of the abscess. Simple irrigation and intraoperative aspiration with suction was ineffective. The patient remained in the hospital for approximately three weeks and was discharged to a long-term acute care facility. Over the next five months her motor function gradually improved and she was discharged to home. Currently, she remains at home, free of significant pain and able to ambulate independently.