Spinal epidural abscess in an adolescent male: an unusual etiology and the role of intraoperative ultrasound

Abstract

Background: Pediatric spinal epidural abscess is considered to be a rare illness. Despite all the recent improvements in the diagnosis and the treatment of this rare condition, the morbidity and mortality rate is still high especially if the diagnosis was not achieved early on.

Purpose: The purpose of this paper is to review the current literature on spinal epidural abscess (SEA) in the pediatric population, with a focus on understanding the clinical presentation, diagnosis, management strategies, and outcomes. This review aims to highlight the unique aspects of SEA and underscore the role of imaging, including intraoperative ultrasound, in guiding treatment.

Methods: A literature review was conducted to analyze the existing research on SEA in the pediatric population from the year 2000 to the present. Patients with tuberculosis and predisposing factors were excluded from the analysis.

Results: We found 42 cases of SEA in patients without significant predisposing factors. The most commonly reported symptoms were back pain, fever, and neurological deficits. Early surgical decompression coupled with targeted antibiotic therapy resulted in improved neurological outcomes and reduced morbidity.

Conclusion: Current literature reveals no clear consensus on the optimal management of (SEA). Each treatment modality presents distinct considerations. However, a trend favoring surgical management is apparent in the reviewed literature, likely due to the risk of disease progression associated with medical management alone. MRI remains the gold standard for diagnosis, but intraoperative ultrasound may offer added benefits during surgical management.

Keywords: Intraoperative ultrasound; Pediatric; Spinal epidural abscess.