Surgical Decompression and Continuous Epidural Irrigation for Extensive Spinal Epidural Abscess Secondary to Psoas Major Muscle Abscess

Summary

This article presents the case of a patient with an extensive spinal epidural abscess (SEA), detailing the surgical intervention and subsequent clinical outcomes.

Abstract

An extensive spinal epidural abscess (SEA) is a rare and life-threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. When an SEA is widespread, extensive decompression with laminectomy is often impossible, as it may subject the patient to very long operative times, extensive blood loss, and mechanical instability. Here we report a 57-year-old male patient who presented to the emergency department with high-grade fever, significantly diminished muscle strength in the right limbs, nuchal rigidity, and hyperreflexia in both lower limbs. Magnetic resonance imaging (MRI) of the spine revealed a diffuse spinal epidural abscess extending from C2 to S1. Laboratory investigations were consistent with prominent signs of acute infection. He underwent emergent surgical intervention, complemented by postoperative continuous epidural irrigation combined with antibiotic therapy. The postoperative course was favorable, with the patient demonstrating marked clinical improvement. Based on this case, we conclude that prompt surgical drainage combined with continuous epidural irrigation and adjunctive antibiotic therapy represents a viable clinical approach for the management of SEA.

Introduction

Spinal epidural abscess (SEA) is a rare but potentially devastating infection, historically affecting 0.2-2 per 10,000 hospital admissions¹, though recent evidence suggests a rising incidence potentially reaching up to 5.1 per 10,000 admissions². This increase is attributed to factors like an aging population, improved diagnostics, comorbidities such as diabetes mellitus and immunocompromised states, intravenous drug use, and the growing prevalence of spinal instrumentation^3,4. Extensive SEA, variably defined as involving more than five vertebral levels or spanni....

Protocol

This protocol follows the guidelines of the Human Research Ethics Committee of First Affiliated Hospital, Zhejiang University School of Medicine. Written informed consent was obtained from the patients for participation in the study. The required consumables and equipment are listed in the Table of Materials.

1. Operative procedure

1. Preoperative preparation: Comprehensive laboratory and imaging studies excluded absolute surgical contraindications. The patient was planned to undergo general anesthesia for C3 cervical and T9 thoracic laminectomy with decompression and epidural abscess debridem....

Results

This patient successfully underwent a laminectomy with decompression and epidural abscess debridement, followed by antibiotics and continuous spinal irrigation. At the 2-week postoperative reassessment, cervical-thoracic-lumbar MRI demonstrated significant resolution of the epidural abscesses but still with small residuals (Figure 3). Subsequent removal of irrigation catheters and surgical drains was performed following normalization of inflammatory markers (CRP 3.2 mg/L, WBC 6.8×10⁹

Discussion

SEA is a severe infection with a global mortality rate of 5%-16%, and fewer than 50% of survivors fully recover. Males are affected more frequently than females, with a ratio of 2:1, for reasons that remain unknown¹¹. SEAs manifest as a multisegmental (3-4 segments) condition because bacteria can spread through the epidural space unhindered by anatomical barriers¹². This report presents a challenging case of holocord SEA spanning C2-S1, uniquely originating from a psoas mus.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Absorbable Suture	ETHICON	VCP739D
Absorbable Suture	ETHICON	SXPP1A404
AGILENT 2100 Bioanalyzer	AGILENT	2100
DeepARG	gaarangoa	https://github.com/gaarangoa/deeparg
Fastp	OpenGene	https://github.com/OpenGene/fastp
Illumina NextSeq 550 Sequencing System	Illumina	https://www.illumina.com/systems/sequencing-platforms/nextseq/specifications.html	Sequencer
Kraken2	DerrickWood	https://github.com/DerrickWood/kraken2
Maxima Reverse Transcriptase	Thermo Fisher	18080093
Nextera XT DNA Library Prep Kit	Illumina	https://www.illumina.com/products/by-type/sequencing-kits/library-prep-kits/nextera-xt-dna.html	DNA library preparation kit
Nuclease	Thermo Fisher	EN0321
QIAamp Circulating Nucleic Acid Kit	QIAGEN	55114	Circulating nucleic acid Kit
QIAamp UCP Pathogen DNA Kit	QIAGEN	50214	DNA/RNA extraction kits
QIAamp Viral RNA Kit	QIAGEN	52904
Ribo-Zero rRNA Removal Kit	Illumina	https://www.illumina.com/products/by-type/molecular-biology-reagents/ribo-zero-plus-rrna-depletion.html	rRNA depletion kit
Skin Stapler	Covidien	54887
Tween 20	SIGMA	P9416