A Case Report of Selective Skip Laminectomies and Subsequent Catheter Irrigation of a Holospinal Epidural Abscess

Abstract

Background: Holospinal epidural abscesses (HEAs) are exceedingly rare, with less than 25 case reports of the condition found in the literature. Broad-spectrum antibiotics are virtually always indicated in its treatment upon its diagnosis, which is typically made via magnetic resonance imaging (MRI). Furthermore, if fulminant neurological deterioration presents, surgical debridement of the infection can help reduce the infectious burden and improve long-term outcomes. Access to the epidural space is attained via laminectomies; however, extensive laminectomies can destabilize the spine. Various case reports noted that selective laminectomies at particular vertebrae can avoid this destabilization, while still allowing catheter access to the length of the spinal cord. Case Information: Our patient was a 60-year-old male who presented with altered mental status, neck pain, and fever. He was diagnosed with methicillin-resistant Staphylococcus aureus meningitis and bacteremia. An MRI revealed an epidural abscess running from the cervical spine through the lumbar spine with concomitant compression of the spinal cord, as well as numerous paraspinal musculature abscesses and a retropharyngeal/prevertebral abscess. The patient was started on broad-spectrum IV antibiotics; however, his condition continued to deteriorate. The decision was made to perform a surgical debridement. Laminectomies were performed at vertebrae T4 and T10, and catheters were then run cranially and caudally through these points to access the length of the spinal canal. The purulent material was aspirated, and an antibiotic solution was then used to irrigate the epidural space; meanwhile, the patient was cycled between Trendelenburg and Reverse Trendelenburg positions to facilitate drainage of the purulent material. Following the procedure, the patient's neurological status started to improve. He was kept on vancomycin postoperatively until his elevated inflammatory markers resolved. The patient recovered fully, and at three months follow-up had no neurological deficits. Conclusions: This surgical technique is an effective way to identify the inciting organism in a HEA, reduce the infectious burden, decompress the spinal cord, minimize surgical time and blood loss, and maintain stability of the spine without the use of instrumentation.