Spinal epidural abscess (SEA) is a rare but often devastating
infection of the epidural space around the spinal cord. When an SEA is widespread, extensive
decompression with
laminectomy is often impossible, as it may subject the patient to very long
operative times, extensive blood loss, and mechanical instability. A technique called "skip
laminectomy" has been described in the literature, in which
laminectomies are performed at the rostral and caudal ends of an
abscess that spans 3-5 levels and a Fogarty
catheter is used to mechanically drain the
abscess, much like in an
embolectomy. In this report of 2 patients, the authors present a modification of this technique, which they call "apical
laminectomies" to allow for irrigation and drainage of an extensive SEA spanning the entire length of the vertebral column (C1-2 to L5-S1). Two patients presented with cervico-thoraco-lumbar SEA.
Laminectomies were performed at the natural apices of the spine, namely, at the midcervical, midthoracic, and midlumbar spine levels. Next, a pediatric
feeding tube was inserted in the epidural space from the thoracic
laminectomies up toward the cervical
laminectomy site and down toward the lumbar
laminectomy site, and saline
antibiotics were used to irrigate the SEA. Both patients underwent this procedure with no adverse effects. Their SEAs resolved both clinically and radiologically. Neither patient suffered from mechanical instability at 1 year
after treatment. For patients who present with extensive SEAs, apical
laminectomies seem to allow for surgical cure of the infectious burden and do not subject the patient to extended operating room time, an increased risk of blood loss, and the risk of mechanical instability.