title: The sacral hiatus approach for drainage of anterior lumbo-sacral epidural abscesses. A case report and technical note.
abstract: 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.
authors.affiliation: Department of Neurosurgery, University of California, Irvine, CA, USA. mmathews@uci.edu
authors.forename: Marlon S
authors.initials: MS
authors.lastname: Mathews
authors.forename: J
authors.initials: J
authors.lastname: Ospina
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D003287:Contrast Media; D004322:Drainage / Q000379:methods*; D020802:Epidural Abscess / Q000601:surgery*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D012447:Sacrum / Q000601:surgery*
chemical_list: D003287:Contrast Media