Two-tuohy needle and catheter technique for fluoroscopically guided percutaneous drainage of spinal epidural abscess: a case report.
BACKGROUND
The incidence of spinal epidural abscess has increased in the past decades. Traditionally, management was based on surgical decompression. More recent studies have shown conservative management has successful outcomes in selected patients.


METHODS
We present a case, in which an elderly woman presented with new onset radicular pain and mild leukocytosis more than a week after a complicated revision of an intrathecal catheter in place for management of chronic axial low back pain. Magentic resonance imaging (MRI) revealed a posterior epidural abscess from T12 to L2. Two Touhy needles were placed in the epidural space with fluoroscopic guidance for drainage of the abscess. A catheter was then advanced into the epidural space for irrigation with saline and an antibiotic solution. Intravenous antibiotics were continued for a total of 6 weeks. Radicular pain resolved immediately post-procedure. Serial MRIs also showed decreasing size of the abscess.


CONCLUSIONS
Posterior spinal epidural abscesses may be successfully treated by way of the two Touhy needle and catheter technique for drainage and irrigation. This procedure should be reserved for patients that present with no neurological deficits or deemed nonsurgical candidates. Patients should continue on prolonged intravenous antibiotics and be monitored closely for clinical deterioration and undergo serial follow-up MRIs.
Perez-Toro
Marco R
MR
University of Texas-MD Anderson Cancer Center, Houston, TX 77004, USA. perez_mr@yahoo.com
Burton
Allen W
AW
Hamid
Basem
B
Koyyalagunta
Dhanalakshmi
D
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000150:complications; D002404:Catheterization; D002408:Catheters, Indwelling / Q000009:adverse effects; D020806:Central Nervous System Bacterial Infections / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods*; D020802:Epidural Abscess / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae; D008223:Lymphoma / Q000150:complications; D009339:Needles; D011183:Postoperative Complications / Q000382:microbiology / Q000601:surgery; D016868:Serratia Infections / Q000209:etiology / Q000601:surgery*; D012706:Serratia marcescens; D016103:Spinal Fractures / Q000150:complications; D055009:Spondylosis / Q000150:complications / Q000601:surgery; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae
D000701:Analgesics, Opioid; D004091:Hydromorphone