| Summary: | Background and importance: Pan-regional (i.e. cervico-thoraco-lumbo-sacral [CTLS]) spinal epidural abscess (SEA) is rare: only 7 cases have been reported to date.
Clinical presentation: A 68 year old male, without immunosuppression, presented with severe thoracic back pain and fulminant septicaemia. CT and MRI revealed a Pan-regional CTLS SEA associated with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis. Blood cultures grew Staphylococcus aureus sensitive to flucloxacillin and rifampicin. Given the extent of suppuration, the lack of a clinical spinal ‘level’, as well as haemodynamic instability, neurosurgical management was conservative: with intravenous flucloxacillin and rifampicin. Over several weeks, his condition slowly improved: but at no point was any spinal ‘level’ apparent neurologically. He eventually made a complete clinical and radiological recovery without any operation which was maintained at one year review.
Conclusion: Even pan-regional CTLS SEA with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis can be managed non-operatively. A complete clinical and radiological resolution can be achieved with antibiotics alone.
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