{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:19:55Z","timestamp":1792621195617,"version":"4.5.0"},"reference-count":114,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:p>Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects.<\/jats:p>\n                  <jats:p>Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.<\/jats:p>","DOI":"10.3171\/2014.5.focus14136","type":"journal-article","created":{"date-parts":[[2014,8,1]],"date-time":"2014-08-01T03:47:18Z","timestamp":1406864838000},"page":"E11","source":"Crossref","is-referenced-by-count":21,"title":["Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques"],"prefix":"10.3171","volume":"37","author":[{"given":"Gabriel A.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals, Case Medical Center;"},{"name":"Case Western Reserve University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshneel S.","family":"Kochar","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Manjila","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals, Case Medical Center;"},{"name":"Case Western Reserve University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaine","family":"Onwuzulike","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals, Case Medical Center;"},{"name":"Case Western Reserve University School of Medicine; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert T.","family":"Geertman","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine; and"},{"name":"Department of Neurological Surgery, MetroHealth Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine; and"},{"name":"Department of Neurological Surgery, MetroHealth Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine; and"},{"name":"Department of Neurological Surgery, MetroHealth Medical Center, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9B","key":"b1-focus14136","series-title":"Arq Neuropsiquiatr","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1590\/0004-282X20130158","article-title":"Steroids in neuroinfection","volume":"71","author":"Abraham","year":"2013"},{"key":"b2-focus14136","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"344","DOI":"10.3171\/2013.11.SPINE13527","article-title":"Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature. 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