Spinal epidural abscess in children: a case-based review

Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

“…The incidence of SEA is low ranging from 0.2 to 1.2 patients per 10,000 hospital admissions and is more common in adults than in children with a peak between 50 and 70 years old [ 3 , 5 ]. The mean age of SEA in children is about eight years [ 6 ] and is usually related to previous lumbar puncture, epidural anesthesia, or spinal surgery [ 7 ].…”

“…The usual location for SEA is the mid-thoracic to the lumbar spine due to the narrowing of the spinal cord at these levels leading to a larger epidural space; the epidural venous plexus is the presumed route of infection. Most SEAs are dorsal, with ventral abscesses being rare because of the adherence of the posterior longitudinal ligament to the dura mater ventrally, leaving a small potential space [ 5 ].…”

“…The following four clinical stages have been described in the progression of the disease: (1) spinal pain, fever, and local tenderness are the presenting symptoms; (2) radicular pain, nuchal rigidity, and changes in the reflexes then appear; (3) sensory and motor abnormalities arise, including bowel and bladder dysfunction, as the disease goes untreated; and (4) paralysis then occurs as neurologic deficits become permanent. Alterations are reversible up to stage four, and paralysis lasting longer than 24-36 hours is unlikely to improve [ 5 ].…”

“…The extensive laminectomy advised for the treatment of SEA in adults is undesirable in children as widespread decompression potentially predisposes patients to complications such as instability, postoperative low-back pain, cardiac and respiratory difficulties, and late kyphotic deformity [ 4 ]. Consideration of these complications is particularly important in the pediatric population given their skeletal immaturity and longer life expectancy [ 5 ]. Given this concern, there have been multiple reports of skip, limited and apical laminectomies with or without catheter irrigation, and of conservative management with antibiotic therapy alone without drainage [ 5 , 18 - 27 ].…”

“…Consideration of these complications is particularly important in the pediatric population given their skeletal immaturity and longer life expectancy [ 5 ]. Given this concern, there have been multiple reports of skip, limited and apical laminectomies with or without catheter irrigation, and of conservative management with antibiotic therapy alone without drainage [ 5 , 18 - 27 ].…”