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Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage
Adam A Ammar1, Mousa K Hamad1, Malik S Obeidallah1
1Department of Neurological Surgery, Montefiore Medical Center, Moses Campus, Bronx, USA.
Insights
A rare spinal epidural abscess (SEA) in an infant was successfully treated using a percutaneous epidural drain and antibiotics. This minimally invasive approach offers a viable alternative to surgery for pediatric SEA cases.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Spinal epidural abscess (SEA) is a serious neurological condition often requiring surgical intervention.
- Treatment options for pediatric SEA, especially in infants, are limited and carry significant risks.
- Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infections, including SEA.
Observation:
- An 11-month-old immunocompetent infant presented with a large lung abscess extending into the epidural space (C7-L2), causing spinal cord compression.
- The infant had a holo-spinal epidural abscess, a rare presentation in this age group.
- The abscess was caused by methicillin-resistant Staphylococcus aureus (MRSA).
Findings:
- Successful treatment of the infant's extensive SEA was achieved using percutaneous placement of an indwelling epidural drainage catheter combined with antibiotic therapy.
- This minimally invasive technique led to complete resolution of the spinal epidural abscess.
- No prior reports document the successful use of percutaneous indwelling catheters for complete SEA resolution.
Implications:
- Percutaneous indwelling epidural drain placement presents a safe and effective alternative to surgical decompression for pediatric SEA.
- This approach may reduce the risks associated with traditional surgical interventions in infants.
- The findings contribute valuable insights into managing rare holo-spinal epidural abscesses in children.
Abstract:
Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant Staphylococcus aureus abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Holo-spinal epidural abscess in an infant is an extremely rare disease with limited literature available regarding the best practice for its treatment. Multiple considerations must be taken into account when weighing the different treatment options ranging from surgical decompression to conservative management with antibiotic therapy. We present a unique case of successful treatment with percutaneous epidural drain placement. This provides a reasonable alternative for management in children for whom surgical decompression carries multiple risks for complications both acutely and delayed.
