Pan-regional (cervico-thoraco-lumbo-sacral) spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

• Total pan-regional (i.e. cervico-thoraco-lumbo-sacral [CTLS]) spinal epidural abscess (SEA) is rare: only 2 cases have been previously reported.
• In recent years, there has been a trend with even extensive multi-regional SEA towards operative intervention; with multi-level laminectomies and blind irrigation through inserted catheters.
• We have comprehensively reviewed cases published (since 1981 to the present date) of the management of pan-regional spinal epidural abscesses.
• We present the case of a total pan-regional CTLS SEA, associated with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis, which was managed entirely non-operatively.
• Our patient fully recovered, with a complete clinical and radiologic resolution of all infected structures that was maintained at one year off all medication.

Background and importancePan-regional (i.e. cervico-thoraco-lumbo-sacral [CTLS]) spinal epidural abscess (SEA) is rare: only 7 cases have been reported to date.Clinical presentationA 68 year old male, without immunosuppression, presented with severe thoracic back pain and fulminant septicaemia. CT and MRI revealed a Pan-regional CTLS SEA associated with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis. Blood cultures grew Staphylococcus aureus sensitive to flucloxacillin and rifampicin. Given the extent of suppuration, the lack of a clinical spinal ‘level’, as well as haemodynamic instability, neurosurgical management was conservative: with intravenous flucloxacillin and rifampicin. Over several weeks, his condition slowly improved: but at no point was any spinal ‘level’ apparent neurologically. He eventually made a complete clinical and radiological recovery without any operation which was maintained at one year review.ConclusionEven pan-regional CTLS SEA with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis can be managed non-operatively. A complete clinical and radiological resolution can be achieved with antibiotics alone.