Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature

  • Luca Proietti
  • Luca Ricciardi
  • Giovanni Noia
  • Giuseppe Barone
  • Eugenio Valenzi
  • Andrea Perna
  • Ilaria Giannelli
  • Laura Scaramuzzo
  • Massimiliano Visocchi
  • Fabio Papacci
  • Francesco Ciro Tamburrelli
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


Purpose: An extensive spinal epidural abscess is a rare condition and causes significant morbidity and mortality. Few authors have described this uncommon entity, which requires early diagnosis and optimal treatment to avoid devastating complications. The purpose of this study was to evaluate a minimally invasive technique for treatment of an extensive spinal epidural abscess by describing two cases. Furthermore, we conducted a review of the recent literature on the management of this rare condition.

Methods: We report two cases of spinal abscesses extending to the whole epidural space, successfully treated by use of a minimally invasive technique consisting of multilevel laminotomy and catheter irrigation to decompress and drain the epidural space.

Results: This technique is able to decompress the spinal cord, isolate the pathogen and evacuate the abscess. No complications, late spine deformity or dura penetration were observed in our patients.

Conclusion: Urgent surgical decompression, in combination with long-term antibiotic treatment, is generally considered the treatment of choice for an extensive spinal epidural abscess. A minimally invasive technique can be very useful as a surgical option.


Extensive spinal epidural abscess Holocord abscess Minimally invasive surgery 


Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

No financial support was received for this work.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The patients discussed in this paper have expressed their consent for the presentation of their cases and the processing of their personal data.


  1. 1.
    Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol. 1998;38:225–31.CrossRefGoogle Scholar
  2. 2.
    Ansari A, Davies DW, Lohn JW, Culpan P, Etherington G. Extensive spinal epidural abscess associated with an unremarkable recovery. Anaesth Intensive Care. 2004;32:825–9.PubMedGoogle Scholar
  3. 3.
    Schultz K Jr, Comey C, Haid R Jr. Technical note. Pyogenic spinal epidural abscess: a minimally invasive technique for multisegmental decompression. J Spinal Disord. 2001;14(6):546–9.CrossRefGoogle Scholar
  4. 4.
    Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355:2012–20.CrossRefGoogle Scholar
  5. 5.
    Davis DP, Wold RM, Patel RJ, Tran AJ, Tokhi RN, Chan TC, Vilke GM. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2006;26:285–91.CrossRefGoogle Scholar
  6. 6.
    Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess—experience with 46 patients and evaluation of prognostic factors. J Infect. 2002;45:76–81.CrossRefGoogle Scholar
  7. 7.
    Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine. 1992;71:369–85.CrossRefGoogle Scholar
  8. 8.
    Rigamonti D, Liem L, Sampath P, Knoller N, Namaguchi Y, Schreibman DL, Sloan MA, Wolf A, Zeidman S. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999;52:189–96.CrossRefGoogle Scholar
  9. 9.
    Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery. 2002;51:79–85.CrossRefGoogle Scholar
  10. 10.
    Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008;101(1):1–12.CrossRefGoogle Scholar
  11. 11.
    Ruiz A, Post MJ, Sklar EM, Holz A. MR imaging of infections of the cervical spine. Magn Reson Imaging Clin N Am. 2000;8:561–80.PubMedGoogle Scholar
  12. 12.
    Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med. 1948;239:845–54.CrossRefGoogle Scholar
  13. 13.
    Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014;14(2):326–30.CrossRefGoogle Scholar
  14. 14.
    Adogwa O, Karikari IO, Carr KR, Krucoff M, Ajay D, Fatemi P, Perez EL, Cheng JS, Bagley CA, Isaacs RE. Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature: clinical article. J Neurosurg Spine. 2014;20:344–9.CrossRefGoogle Scholar
  15. 15.
    Euba G, Narváez JA, Nolla JM, Murillo O, Narváez J, Gómez-Vaquero C, Ariza J. Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum. 2008;38:28–40.CrossRefGoogle Scholar
  16. 16.
    Küker W, Mull M, Mayfrank L, Töpper R, Thron A. Epidural spinal infection. Variability of clinical and magnetic resonance imaging findings. Spine. 1997;22:544–51.CrossRefGoogle Scholar
  17. 17.
    Pfister HW, von Rosen F, Yousry T. MRI detection of epidural spinal abscesses at noncontiguous sites. J Neurol. 1996;243:315–7.CrossRefGoogle Scholar
  18. 18.
    Payer M, Walser H. Evacuation of a 14-vertebral-level cervico-thoracic epidural abscess and review of surgical options for extensive spinal epidural abscesses. J Clin Neurosci. 2008;15:483–6.CrossRefGoogle Scholar
  19. 19.
    Urrutia J, Rojas C. Extensive epidural abscess with surgical treatment and long term follow up. Spine J. 2007;7(6):708–11.CrossRefGoogle Scholar
  20. 20.
    Chang WC, Tsou HK, Kao TH, Yang MY, Shen CC. Successful treatment of extended epidural abscess and long segment osteomyelitis: a case report and review of the literature. Surg Neurol. 2008;69:117–20.CrossRefGoogle Scholar
  21. 21.
    Gorchynski J, Hwang J, McLaughlin T. A methicillin-resistant Staphylococcus aureus–positive holospinal epidural abscess. Am J Emerg Med. 2009;27:514.e7–9.Google Scholar
  22. 22.
    Smith C, Kavar B. Extensive spinal epidural abscess as a complication of Crohn’s disease. J Clin Neurosci. 2010;17:144–6.CrossRefGoogle Scholar
  23. 23.
    Van Bergen J, Plazier M, Baets J, Jan Simons P. An extensive spinal epidural abscess successfully treated conservatively. J Neurol Neurosurg Psychiatry. 2009;80:351–3.CrossRefGoogle Scholar
  24. 24.
    Elsamaloty H, Elzawawi M, Abduljabar A. A rare case of extensive spinal epidural abscess in a diabetic patient. Spine. 2010;35(2):E53–6.CrossRefGoogle Scholar
  25. 25.
    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.CrossRefGoogle Scholar
  26. 26.
    Deshmukh VR. Midline trough corpectomies for the evacuation of an extensive ventral cervical and upper thoracic spinal epidural abscess. J Neurosurg Spine. 2010;13:229–33.CrossRefGoogle Scholar
  27. 27.
    Lehman RA, Lenke G. Extensive epidural abscess treated with a thoracic laminoplasty. Spine J. 2011;11(8):798–9.CrossRefGoogle Scholar
  28. 28.
    O’Brien C, Lenehan B, Street J. Non-operative management of an extensive anteriorly located epidural abscess. J Clin Neurosci. 2011;18:1401–2.CrossRefGoogle Scholar
  29. 29.
    Lau D, Maa J, Mummaneni PV, Chou D. Holospinal epidural abscess. J Clin Neurosci. 2014;21:517–20.CrossRefGoogle Scholar
  30. 30.
    Lee JS, Choi SM, Kim KW. Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report. Spine J. 2013;13:e9–e14.PubMedGoogle Scholar
  31. 31.
    Velpula JM, Gakhar H, Sigamoney H, Bommireddy R. Cervical epidural abscess mimicking as stroke—report of two cases. Open Orthop J. 2014;8:20–3.CrossRefGoogle Scholar
  32. 32.
    Shiu SI, Lee BJ, Chen HC, Lin YH, Wang CY. Holospinal epidural abscess complicated with bilateral psoas muscle abscess. Spine J. 2014;14:1072–3.CrossRefGoogle Scholar
  33. 33.
    Smith GA, Kochar AS, Manjila S, Onwuzulike K, Geertman RT, Anderson JS, Steinmetz MP. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques. Neurosurg Focus. 2014;37(2):E11.CrossRefGoogle Scholar
  34. 34.
    Killen MC, Hernandez M, Berg A, Bhatia C. Nonoperative management of a multi-regional epidural abscess with neurological dysfunction. Int J Spine Surg. 2015;9:47.CrossRefGoogle Scholar
  35. 35.
    Abd-El-Barr MM, Bi WL, Bahluyen B, Rodriguez ST, Groff MW, Chi JH. 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.CrossRefGoogle Scholar
  36. 36.
    Lange M, Tiecks F, Schielke E, Yousry T, Haberl R, Oeckler R. Diagnosis and results of different treatment regimes in patients with spinal abscesses. Acta Neurochir. 1993;125:105–14.CrossRefGoogle Scholar
  37. 37.
    Firsching R, Frowein RA, Nittner K. Acute spinal epidural empyema: observations from seven cases. Acta Neurochir. 1985;74:68–71.CrossRefGoogle Scholar
  38. 38.
    Hancock DO. A study of 49 patients with acute spinal extradural abscess. Paraplegia. 1973;10:285–8.CrossRefGoogle Scholar
  39. 39.
    Ahl T, Hedstrom M, Von Heijne A, Stiernstedt SH. Acute spinal epidural abscess without concurrent spondylodiscitis. Acta Orthop Scand. 1999;70:199–202.CrossRefGoogle Scholar
  40. 40.
    Leys D, Lesoin F, Viaud C, Pasquier F, Rousseaux M, Jomin M, Petit H. Decreased morbidity from acute bacterial spinal epidural abscess using computed tomography and nonsurgical treatment in selected patients. Ann Neurol. 1985;17:350–5.CrossRefGoogle Scholar
  41. 41.
    Panagiotopoulos V, Konstantinou D, Solomou E, Panagiotopoulos E, Marangos M, Maraziotis T. Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique. Spine. 2004;29:300–3.CrossRefGoogle Scholar
  42. 42.
    Stewart IC, Ford MJ, Heading RC. Acute spinal epidural abscesses—a cause of meningism. Scott Med J. 1981;26:348–9.CrossRefGoogle Scholar
  43. 43.
    Wheeler D, Keiser P, Rigamonti D, Keay S. Medical management of spinal epidural abscesses: case report and review. Clin Infect Dis. 1992;15:22–7.CrossRefGoogle Scholar
  44. 44.
    Lyu RK, Chen CJ, Tang LM, Chen ST. 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.CrossRefGoogle Scholar
  45. 45.
    Richmond B, Schmidt J. Seventeen level laminectomy for extensive spinal epidural abscess: case report and review. W V Med J. 1994;90:468–71.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Luca Proietti
    • 1
  • Luca Ricciardi
    • 2
  • Giovanni Noia
    • 1
  • Giuseppe Barone
    • 3
  • Eugenio Valenzi
    • 1
  • Andrea Perna
    • 1
  • Ilaria Giannelli
    • 1
  • Laura Scaramuzzo
    • 4
  • Massimiliano Visocchi
    • 2
  • Fabio Papacci
    • 2
  • Francesco Ciro Tamburrelli
    • 1
  1. 1.Spine Surgery Division, Agostino Gemelli HospitalCatholic University of the Sacred Heart of RomeRomeItaly
  2. 2.Institute of Neurological SurgeryCatholic University of the Sacred Heart of Rome, Agostino Gemelli HospitalRomeItaly
  3. 3.Division of Orthopaedics and Traumatology, Santa Maria della Misericordia HospitalUniversity of PerugiaPerugiaItaly
  4. 4.Spine Surgery Division 1IRCCS Galeazzi Orthopaedic InstituteMilanItaly

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