“Through and Through” Fluoroscopically Guided Catheter Drainage of Extensive Spinal Epidural Abscess: A Case Report
Keywords:through and through spinal irrigation, fluoroscopically guided catheter drainage, extensive epidural abscess, minimally-invasive surgery for spinal drainage
Purpose: We aimed to present a case of spondylodiscitis with extensive spinal epidural abscess (SEA) that was successfully treated using a minimally invasive technique supplemented with fluoroscopically guided catheter drainage and systemic antibiotic therapy.
Methods: A 58-year-old man presented with severe back pain and high-grade fever. He had progressive radiating pain in the lower extremities, followed by sensory deficits in both the lower limbs. Laboratory investigations revealed leukocytosis and high C-reactive protein levels. Magnetic resonance imaging of the thoracic and lumbar regions revealed an extremely large posterior SEA that extends from T6 to S1. As the patient did not respond to intravenous antibiotics alone, he underwent skipped laminectomies with fluoroscopically guided catheter drainage and irrigation.
Results: Escherichia coli were detected in purulent material from the abscess. His clinical symptoms were dramatically and immediately relieved after the procedure. The patient achieved complete neurological recovery after six weeks of antibiotic therapy.
Conclusions: We suggest a limited approach to the spine with the use of small radio-opaque catheters, representing an interesting option to effectively drain extensive SEAs with less morbidity than the conventional open extensive surgical drainage.
Schwab JH, Shah AA. Spinal epidural abscess: diagnosis, management, and outcomes. J Am Acad Orthop Surg 2020;28:e929-23. DOI: https://doi.org/10.5435/JAAOS-D-19-00685
Zimmerer SM, Conen A, Muller AA, et al. Spinal epidural abscess: etiology, predisponent factors and clinical outcomes in a 4-year prospective study. Eur Spine J 2011;20:2228-34. DOI: https://doi.org/10.1007/s00586-011-1838-y
Lara-Reyna J, Yaeger KA, Margetis K. Transpedicular approach for ventral epidural abscess evacuation in the cervical spine. World Neurosurg 2021;145:127-33. DOI: https://doi.org/10.1016/j.wneu.2020.09.062
Sharfman ZT, Gelfand Y, Shah P, et al. Spinal epidural abscess: a review of presentation, management, and medicolegal implications. Asian Spine J 2020;14:742-59. DOI: https://doi.org/10.31616/asj.2019.0369
Darouiche RO. Spinal epidural abscess. N Engl J Med 2006;355:2012-20. DOI: https://doi.org/10.1056/NEJMra055111
Panagiotopoulos V, Konstantinou D, Solomou E, et al. Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique. Spine (Phila Pa 1976) 2004;29:E300-3. DOI: https://doi.org/10.1097/01.BRS.0000131215.46119.DD
Smith GA, Kochar AS, Manjila S, et al. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques. Neurosurg Focus 2014;37:E11. DOI: https://doi.org/10.3171/2014.5.FOCUS14136
Andre V, Pot-Vaucel M, Cozic C, et al. Septic arthritis of the facet joint. Med Mal Infect 2015;45:215-21. DOI: https://doi.org/10.1016/j.medmal.2015.04.001
Muffoletto AJ, Ketonen LM, Mader JT, et al. Hematogenous pyogenic facet joint infection. Spine (Phila Pa 1976) 2001;26:1570-6. DOI: https://doi.org/10.1097/00007632-200107150-00014
Du JY, Schell AJ, Kim C-Y, et al. 30-Day mortality following surgery for spinal epidural abscess: incidence, risk factors, predictive algorithm, and associated complications. Spine (Phila Pa 1976) 2019;44:E500-9. DOI: https://doi.org/10.1097/BRS.0000000000002875
Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM 2008;101:1-12. DOI: https://doi.org/10.1093/qjmed/hcm100
Richmond B, Schmidt 3rd JH. Seventeen level laminectomy for extensive spinal epidural abscess: case report and review. W V Med J 1994;90:468-71.
Denis DJ, Champagne P-O, Hoffman H, et al. Catheter-based minimally invasive evacuation of extensive spinal epidural abscess: A technical report. Cureus 2019;11:e4649. DOI: https://doi.org/10.7759/cureus.4649
Lyu R-K, Chen C-J, Tang L-M, et al. Spinal epidural abscess successfully treated with percutaneous, computed tomography–guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery 2002;51:509-12. DOI: https://doi.org/10.1097/00006123-200208000-00039
Curry WT, Hoh BL, Amin-Hanjani S, et al. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol 2005;63:364-71. DOI: https://doi.org/10.1016/j.surneu.2004.08.081
Tahir MZ, Hassan RU, Enam SA. Management of an extensive spinal epidural abscess from C-1 to the sacrum. Case report. J Neurosurg Spine 2010;13:780-3. DOI: https://doi.org/10.3171/2010.5.SPINE09545
Abd-El-Barr MM, Bi WL, Bahluyen B, et al. Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases. J Neurosurg Spine 2015;22:318-23. DOI: https://doi.org/10.3171/2014.11.SPINE131166
How to Cite
Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.