Spinal epidural abscess surgery
see also Spinal epidural abscess treatment.
Goals are establishing diagnosis and causative organism, drainage of pus and debridement of granulation tissue, and bony stabilization if necessary. Most spinal epidural abscesses are posterior to the dura and are approached with extensive laminectomy. For posteriorly located spinal epidural abscess and no evidence of vertebral osteomyelitis, instability will usually not follow simple laminectomy and appropriate postoperative antibiotics 1).
Thorough antibiotic irrigation is employed intraoperatively. Primary closure is often employed. Post-op drainage is not necessary in cases with only granulation tissue and no pus. For recurrent infections, reoperation and post-op suction-irrigation may be needed 2).
Patients with associated vertebral osteomyelitis may develop instability after laminectomy alone, 3) especially if significant bony destruction is present. Thus for anterior SEA, usually with osteomyelitis (especially Pott’s disease), a posterolateral extracavitary approach is utilized whenever possible (to avoid transabdominal or transthoracic approach in these debilitated patients) with the removal of devitalized bone usually followed by posterior instrumentation and fusion. Strut grafting with an autologous bone (rib or fibula) can be done acutely in Pott’s disease with little risk of graft infection. With purulent osteomyelitis, metal hardware is not contraindicated (titanium is more resistant to harboring bacteria than stainless steel for several reasons, including the fact that titanium does not permit bacteria to form a glycocalyx on its surface), but bone grafting may run the risk of perpetuating the infection. In this situation, some surgeons use beads of calcium sulfate bone void filler impregnated with an antibiotic (e.g. Stimulan® Rapid Cure™ antibiotic beads).
Biportal endoscopic spinal surgery may be an effective alternative to traditional open surgical decompression for the treatment of SEA 4).
Compared with surgical drainage, fluoroscopy-guided percutaneous epidural drainage is a less invasive treatment option for patients with a poor general condition 5)