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Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.

Publication ,  Journal Article
Abd-El-Barr, MM; Bi, WL; Bahluyen, B; Rodriguez, ST; Groff, MW; Chi, JH
Published in: J Neurosurg Spine
March 2015

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.

Duke Scholars

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

March 2015

Volume

22

Issue

3

Start / End Page

318 / 323

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Therapeutic Irrigation
  • Spine
  • Orthopedics
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Laminectomy
  • Humans
  • Epidural Space
 

Citation

APA
Chicago
ICMJE
MLA
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Abd-El-Barr, M. M., Bi, W. L., Bahluyen, B., Rodriguez, S. T., Groff, M. W., & Chi, J. H. (2015). Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases. J Neurosurg Spine, 22(3), 318–323. https://doi.org/10.3171/2014.11.SPINE131166
Abd-El-Barr, Muhammad M., Wenya Linda Bi, Biji Bahluyen, Samuel T. Rodriguez, Michael W. Groff, and John H. Chi. “Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.J Neurosurg Spine 22, no. 3 (March 2015): 318–23. https://doi.org/10.3171/2014.11.SPINE131166.
Abd-El-Barr MM, Bi WL, Bahluyen B, Rodriguez ST, Groff MW, Chi JH. Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases. J Neurosurg Spine. 2015 Mar;22(3):318–23.
Abd-El-Barr, Muhammad M., et al. “Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.J Neurosurg Spine, vol. 22, no. 3, Mar. 2015, pp. 318–23. Pubmed, doi:10.3171/2014.11.SPINE131166.
Abd-El-Barr MM, Bi WL, Bahluyen B, Rodriguez ST, Groff MW, Chi JH. Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases. J Neurosurg Spine. 2015 Mar;22(3):318–323.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

March 2015

Volume

22

Issue

3

Start / End Page

318 / 323

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Therapeutic Irrigation
  • Spine
  • Orthopedics
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Laminectomy
  • Humans
  • Epidural Space