The Sacral Hiatus Approach for Drainage of Anterior Lumbo-Sacral Epidural Abscesses

Abstract

<jats:p> Lumbosacral epidural abscesses are managed either conservatively with IV antibiotics or with open surgery, particularly in the presence of acute neurological symptoms. Their location makes it difficult for image-guided interventional approaches either for biopsy or evacuation. We report the sacral hiatus and canal as a corridor for image-guided minimally invasive abscess of lumbosacral epidural abscess for aspiration. A 56-year-old man presented to the emergency department complaining of six weeks of worsening low back pain. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as an anterior epidural abscess extending from L4–5 disc space to the S2 vertebral level. Blood cultures grew out gram-positive cocci. For drainage, a 5-French micropuncture kit was utilized to access the hiatus. Under fluoroscopic guidance a microwire was then advanced along the sacral canal. An 18-gauge needle curved to approximate the contours of the sacral canal was then advanced over the guidewire. Once anatomic access was established 2 ml of thick purulent material was aspirated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image-guided aspiration of lumbosacral epidural abscesses can thus be carried out in a safe and effective manner using a sacral hiatus approach. </jats:p>

Minimally Invasive Irrigation for Lumbar Spinal Epidural Abscess using a Trans-Sacral Epiduroscopic Laser Decompression Catheter

“…Yang et al reported improvements in pain with antibiotics and performed percutaneous endoscopic debridement with 10 L of 0.35% dilute betadine solution in 32 patients with spinal infection; their patients recovered without complications . Mathews et al inserted a catheter through the sacral hiatus and obtained an epidural abscess drain and culture sample under fluoroscopic guidance 7) . In our case, I & D was performed through SELD; consequently, the patient showed a rapid recovery and continued for pain relief.…”

Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design

“…92 In general, the paravertebral abscess can be managed by aspiration under CT guidance while epidural abscesses with associated neurological deficits should be managed with open drainage, bone debridement, and interbody fusion with or without fusion. 93,94 While Feldenzer et al established a reliable model of spinal epidural abscess formation, studies investigating the treatment of such abscesses in animal models have not been investigated. 43 Further, few studies investigated the surgical management of spine related infection in an animal model.…”

“…Anterior approaches of debridement and strut grafting with delayed posterior fusions with instrumentation may be an effective strategy in the context of vertebral osteomyelitis with associated spinal instability 92 . In general, the paravertebral abscess can be managed by aspiration under CT guidance while epidural abscesses with associated neurological deficits should be managed with open drainage, bone debridement, and interbody fusion with or without fusion 93,94 …”

Morphometric analysis of the sacral canal and hiatus using multidetector computed tomography for interventional procedures

“…epiduroscopy) of vertebral/spinal diseases (3,10,13). It has been reported that the sacral approach could be used among procedures performed in the spinal area, such as percutaneous intraspinal navigation (PIN) (12).…”