Pediatric cervical epidural abscess in a 4-year-old patient: a case-based update

Area of Science:

• Pediatric Neurosurgery
• Infectious Disease Management
• Spinal Cord Pathology

Background:

• Spinal epidural abscesses (SEAs) in children are rare but serious infections.
• Current treatment strategies for pediatric SEA often involve surgery or prolonged antibiotics, with no established guidelines.
• Management decisions are typically based on individual pediatric neurosurgeon discretion.

Observation:

• A case of cervical spinal epidural abscess with associated cervical and thoracic paraspinous edema and neural foramen widening was managed medically.
• A literature review identified 15 previously reported cases of pediatric SEA.
• The reviewed cases presented varied treatment approaches, including surgical intervention and antibiotic therapy.

Findings:

• The literature review indicated a lack of clear treatment guidelines for pediatric SEA.
• Both surgical laminectomy and long-term antibiotic courses are current treatment mainstays.
• No definitive evidence supports one treatment modality over another in all pediatric SEA cases.

Implications:

• Prompt antibiotic therapy is a potentially effective treatment for pediatric SEA, particularly in cases without neurological deficits.
• This finding suggests that medical management may be a suitable alternative to surgery in select pediatric patients.
• Further research is warranted to establish evidence-based guidelines for pediatric SEA management.