title: Use of Omnipaque Intraoperative Dye in the Surgical Treatment of Pan-Spinal Epidural Abscesses: Technical Case Report.
abstract: BACKGROUND
  Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions.
  
  
  METHODS
  A 57-year-old man presented with lower back pain, which progressed to include urinary retention and evidence of lumbar discitis/osteomyelitis on magnetic resonance imaging. The patient was started on antibiotic therapy. After the patient developed new cervical pain, interval magnetic resonance imaging showed extension of the abscess to involve the cervical, thoracic, and lumbar spine with intraventricular extension. The decision was made to perform a C4 corpectomy and insert a flexible ventriculoperitoneal catheter to serially flush out the abscess. Omnipaque dye was then used to ensure that the entire abscess was evacuated and no septations existed in the anterior epidural space.
  
  
  CONCLUSIONS
  The patient's neurological deficits completely resolved, and he is intact a year after the operation. In selected patients with pan-spinal epidural abscesses associated with acute neurological deficits, a combination of an open approach and a catheter-based procedure in addition to an intraoperative monitoring option to ensure complete evacuation of the abscess and absence of septations in the anterior epidural space is a low-morbidity option in the armamentarium of the surgeon.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Nicolas K
authors.initials: NK
authors.lastname: Khattar
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Zussman
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.forename: Hope K
authors.initials: HK
authors.lastname: George
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Abla
mesh_terms: D003287:Contrast Media; D020802:Epidural Abscess / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007472:Iohexol; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol