1319. Pediatric Cervical Epidural Abscess in a 4 year old Patient: Case Report and Literature Review

Authors: Ranbir Ahluwalia; Andrea Scherer, MD (Orlando, FL)

Introduction:

The purpose of this study was to review a case comprised of a cervical spinal epidural abscess (SEA), cervical and thoracic paraspinous edema, and widening of the right thoracic neural foramen secondary to a phlegmon. While the basis for treatment is primarily based on the presentation of the patient, key indicators for surgery would include the development of neurological signs, or a worsening in inflammatory markers. There is a lack of evidence in the literature defining an optimum guideline for effective treatment, and variability in treatment selection is high. 

Methods:

We reviewed the case of a spinal epidural abscess managed medically in a 4 year old male and performed a meta-analysis with 15 other cases that have previously been reported in the literature. Comparison was made on the basis of age, gender, neurological complications, radiographic findings, surgical treatment, medical treatment, and outcome. 

Results:

The current mainstay of treatment is largely variant, but generally falls into a laminectomy based surgical approach or longstanding antibiotics. Our review of the literature concluded that there are currently no clear guidelines established to recommend treatment, and current practice is largely based on the discretion of the pediatric neurosurgeon. based treatment was given to over 93% of patients studied (medical treatment was not listed for 1 patient). This was largely antibiotic based. There was a large variance in antibiotic selection. Completely normal function was regained in 13 patients. 

Conclusion:

Based on the literature review, and our personal case illustration, we conclude that an antibiotic based treatment is a valid approach for therapy if initiated promptly in a pediatric patient with no neurological deficit.