Surgical Decompression and Continuous Epidural Irrigation for Extensive Spinal Epidural Abscess Secondary to Psoas Major Muscle Abscess.

An extensive spinal epidural abscess (SEA) is a rare and life-threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. 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. Here we report a 57-year-old male patient who presented to the emergency department with high-grade fever, significantly diminished muscle strength in the right limbs, nuchal rigidity, and hyperreflexia in both lower limbs. Magnetic resonance imaging (MRI) of the spine revealed a diffuse spinal epidural abscess extending from C2 to S1. Laboratory investigations were consistent with prominent signs of acute infection. He underwent emergent surgical intervention, complemented by postoperative continuous epidural irrigation combined with antibiotic therapy. The postoperative course was favorable, with the patient demonstrating marked clinical improvement. Based on this case, we conclude that prompt surgical drainage combined with continuous epidural irrigation and adjunctive antibiotic therapy represents a viable clinical approach for the management of SEA.