Management of lumbar spinal epidural abscess using biportal endoscopic approach: a case series

BACKGROUND: Spinal epidural abscesses, though rare, can have devastating consequences if not detected and treated promptly. Surgical treatment involving laminectomy with thorough irrigation and debridement with or without fusion, is the primary option for high-risk patients who may experience recurrence with nonoperative management. The recently developed biportal endoscopic technique provides several advantages over traditional microscopic techniques, including reduced surgical morbidity and continuous wound irrigation throughout the procedure. However, studies involving the use of biportal endoscopic techniques to treat spinal epidural abscesses are rare. This report presents cases of spinal epidural abscesses treated using the biportal endoscopic approach, along with the clinical results and a detailed description of the procedure. METHODS: Patients who underwent biportal endoscopic surgery for spinal epidural abscesses between May 2020 and June 2023 were analyzed. The variables assessed included demographics, laboratory values, microbiological results, perioperative complications, and postoperative outcomes in terms of clinical and laboratory results. The minimum follow-up period was one year. RESULTS: Fifteen patients who underwent biportal endoscopic spinal surgery for the treatment of spinal epidural abscess were included. Intraoperative tissue cultures were positive in eight patients (53%), while three other patients had positive blood or urine cultures, resulting in an overall pathogen identification rate of 73%. All patients showed normalization of the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). The visual analog scale (VAS) leg (5.5 ± 1.9 pre-operatively, 1.6 ± 1.1 1 year postoperatively), VAS back (7.1 ± 1.3, 1.7 ± 0.7), and Oswestry Disability Index (ODI; 67.7 ± 15.3, 13.7 ± 6.2) demonstrated improvement. Based on clinical and laboratory results, all patients were determined to have well-controlled infections, and none required repeat abscess drainage or spinal fusion. CONCLUSIONS: Biportal endoscopic decompressive laminectomy with abscess drainage may be an alternative treatment option for spinal epidural abscesses. While this case series showed improved outcomes after biportal endoscopic treatment for spinal epidural abscesses, further studies, specifically comparing outcomes to those treated with a conventional open approach, are needed.