Fluoroscopy-guided percutaneous needle aspiration of posterior epidural abscesses: a report of two cases.

Introduction: Spinal epidural abscesses are most commonly treated with surgical decompression and antibiotics or in specific instances managed medically with antibiotic therapy alone. Image-guided percutaneous aspiration as an alternative to surgery has only rarely been reported in the literature.

Case Presentation: We report two cases of successful fluoroscopy-guided needle aspiration of posterior epidural abscesses. Case 1 is a 48-year-old man who presented with several days of escalating back pain and constitutional symptoms with MRI showing a posterior epidural abscess at L2-L3 causing spinal stenosis. The patient remained neurologically intact. Percutaneous needle aspiration of the collection provided dramatic pain relief with the aspirate growing methicillin sensitive . The patient made a full recovery on antibiotic therapy. Case 2 is an 81-year-old man who presented with worsening upper back pain and was found to have osteomyelitis/discitis with a large posterior epidural abscess in the thoracic spine. Needle drainage was performed with the sample growing . This patient also responded successfully to nonsurgical management with full recovery after appropriate antibiotic therapy.

Discussion: In carefully selected patients, image-guided needle aspiration of posterior epidural abscesses may be a viable and less invasive alternative to surgery.