Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

Abstract

Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant Staphylococcus aureus abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Holo-spinal epidural abscess in an infant is an extremely rare disease with limited literature available regarding the best practice for its treatment. Multiple considerations must be taken into account when weighing the different treatment options ranging from surgical decompression to conservative management with antibiotic therapy. We present a unique case of successful treatment with percutaneous epidural drain placement. This provides a reasonable alternative for management in children for whom surgical decompression carries multiple risks for complications both acutely and delayed.

Keywords: conservative management; holocord; mrsa; percutaneous drainage; treatment of spinal epidural abscess.

Figure 1. T2 Sagittal MRI of the thoracolumbar (A) and cervicothoracic (B) regions demonstrate posterior epidural collection causing significant cord compression. Post-contrast (C) and DWI (D) imaging confirm the diagnosis of spinal epidural abscess.

MRI: magnetic resonance imaging; DWI: diffusion-weighted imaging

Figure 2. Lateral (A) and posteroanterior (B) radiographs demonstrating needle placement at the L2-3 interspace. Confirmatory posteroanterior (C) and lateral (D) radiographs demonstrate the epidural catheter extending up to approximately the T7 level.

Figure 3. Postoperative CT demonstrating catheter in the epidural space.

CT: computed tomography

Figure 4. Three-week postoperative T2 MRI of the cervicothoracic (A) and thoracolumbar (B) regions demonstrate near-complete resolution of the spinal epidural abscess.

MRI: magnetic resonance imaging