Treatment of Spinal Epidural Abscess With Limited Decompression

Spinal epidural abscess, the collection of purulent material in the epidural space, can cause spinal cord compression and neurologic deficits, including paralysis. Management of spinal epidural abscess includes antibiotic therapy and surgical decompression. Limited evidence is available to guide the extent of surgical decompression necessary for symptom and abscess resolution. Treatment depends on a variety of factors including the size, orientation (ventral or dorsal), and location of the spinal epidural abscess, along with patient-specific factors such as neurologic status.

A 75-year-old male presented with increasing back pain and altered mental status 7 weeks after a motor vehicle crash. The patient had elevated inflammatory markers and was without focal neurologic deficit. Advanced imaging demonstrated a ventral abscess from C2 to T11, a dorsal abscess extending from T9 to T12, ventral and dorsal abscesses from L1 to the sacrum, and myelomalacia from T10 to T12. Limited decompression was performed in the form of T9 to L1 laminectomy for evacuation of the abscess, followed by irrigation with a pediatric Foley catheter. Imaging obtained after surgical intervention and intravenous antibiotic therapy demonstrated complete resolution of the abscesses. The patient's symptoms resolved, and he was doing well at postoperative follow-up.

Our case suggests that extensive decompression may not be necessary for treatment of a large spinal epidural abscess, thus preserving the structural integrity of the spine and potentially minimizing morbidity.