Authors: Oliveira P et al.
Source: Cureus, 18(1), January 14, 2026. DOI: 10.7759/cureus.101533
Summary
This case report describes a rare, fulminant pan-spinal epidural abscess extending continuously from C1 to the sacrum in a 28-year-old man with a history of intravenous drug use. The patient presented with low back pain, fever, progressive ascending weakness, neck stiffness, and respiratory distress, rapidly evolving into quadriparesis and ventilatory failure. Early imaging with whole-spine MRI revealed a posterior and posterolateral epidural abscess across the entire neuraxis, with associated paraspinal muscle collections but no vertebral osteomyelitis.
Within 24 hours of admission, the patient underwent staged cervicothoracic and thoracolumbar laminectomies with catheter-assisted evacuation of purulent material. Cultures confirmed MRSA, prompting targeted intravenous vancomycin therapy. Due to incomplete initial source control, repeat imaging identified residual collections, necessitating a second surgical drainage. Adjunctive hyperbaric oxygen therapy was employed because of the extensive disease burden and inability to fully evacuate infected material during the first operation.
Postoperatively, the patient required prolonged mechanical ventilation but was successfully extubated on day eight. Over the subsequent days, inflammatory markers declined and neurological function partially recovered, with improving lower-extremity strength and preserved upper-extremity motor function, though sphincter dysfunction persisted. The case highlights both the aggressive natural history of holospinal epidural abscess and the feasibility of meaningful neurological recovery with rapid diagnosis, early surgical decompression, targeted antibiotics, and coordinated multidisciplinary care.
Key Points
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Pan-spinal (holospinal) epidural abscess is exceedingly rare and carries high mortality if diagnosis is delayed.
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Intravenous drug use remains a major risk factor, even in young, otherwise healthy patients.
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Whole-spine MRI is essential when neurological deficits are multifocal or rapidly progressive.
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Early, staged multilevel surgical drainage combined with pathogen-directed antibiotics is critical for survival.
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Adjunctive therapies, including hyperbaric oxygen, may be considered in selected extensive or refractory cases.
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Airway and ventilatory management are central due to high risk of respiratory failure with cervical involvement.
Thank you for allowing us to highlight this important case from Cureus, which underscores the life-saving impact of early recognition and coordinated multidisciplinary intervention in catastrophic spinal infections.