Evacuation of a 14-vertebral-level cervico-thoracic epidural abscess and review of surgical options for extensive spinal epidural abscesses

Spinal epidural abscess (SEA) is a rare infection of the spinal peridural space, usually from haematogenous spread of bacteria from a distant source of infection or from direct extension of an osteomyelitis or paravertebral abscess into the spinal canal. An extensive SEA with involvement of five or more levels is even more exceptional and is a very threatening condition. Different surgical strategies have been used in the typically posteriorly located extensive SEA: multi-level laminectomies at all involved levels; catheter procedures, in which suction (irrigation) catheters are pushed cranially and caudally through selected end-level and intermediate-level fenestrations or laminectomies; or multi-level interlaminar fenestrations at the involved levels. We report the evacuation of a 14-vertebral-level cervico-thoracic SEA by multi-level unilateral fenestrations with ‘over-the-top’ removal of contralateral abscess formations at all involved levels. We also discuss the surgical strategies for extensive SEA.