Extensive spinal epidural abscess treated utilizing a single limited incision: illustrative case.

backgroundExtensive spinal epidural abscess is an uncommon and potentially life-threatening condition that mandates appropriate early diagnosis and treatment to avoid potentially disastrous complications. Limited literature is available guiding the management of such an entity. OBSERVATIONS: The authors report the case of a 59-year-old female patient with a history of 5 days of severe back pain, fever, and associated lower limb neurological deficit. MRI revealed an epidural abscess extending from C2 to the sacrum. One-level segmental decompression was performed at the level of L2-3 in combination with the use of an epidurally introduced silicone catheter. Cultures came back positive for methicillin-resistant Staphylococcus aureus. The patient received 6 weeks of antibiotics. The infection was successfully treated after surgery and systemic antibiotic therapy, and full neurological recovery was observed. LESSONS: This is the first report in the literature to describe successful surgical management of an extensive C2-S1 epidural abscess through a single incision and one-level decompression. This less invasive technique could treat the holospinal abscess without the need for other procedures. https://thejns.org/doi/10.3171/CASE24654.