Pan-Spinal Epidural Abcess: Multidisciplinary Management of a Rare and Life-Threatening Condition

We report the case of a 28-year-old male with a history of intravenous drug use who presented with low back pain, progressive paraparesis, fever, and respiratory distress. MRI revealed an extensive epidural abscess from C1 to the sacrum with associated paraspinal muscle collections. Within 24 hours, he underwent staged cervicothoracic and thoracolumbar laminectomies with drainage of purulent material, which cultured methicillin-resistant Staphylococcus aureus. The patient received targeted intravenous vancomycin, completed 10 sessions of hyperbaric oxygen therapy, and required a second surgical drainage for residual abscess. Progressive neurological recovery followed, and he was successfully extubated after eight days. Spinal epidural abscess is an infrequent but potentially life-threatening infection. Pan-spinal or holo-spinal involvement, in which the abscess extends throughout the entire neuraxis, is exceedingly rare and carries high morbidity and mortality. This case highlights the critical importance of maintaining a high index of suspicion, initiating prompt empirical antibiotic therapy, and performing timely multidisciplinary surgical intervention.