Transpedicular Approach for Ventral Epidural Abscess Evacuation in the Cervical Spine

Objective: Spinal epidural abscess may require prompt surgical intervention. Ventral cervical abscesses pose a particular challenge regarding the approach for surgical evacuation. The aim of this article was to describe the technical nuances of a posterior transpedicular cervical approach for evacuation of a ventral epidural abscess. Methods: After a standard laminectomy, a foraminotomy was performed to identify the exiting nerve root. Then the medial aspect of the pedicle below the nerve was drilled. This allowed the insertion of a dissector to reach the ventral epidural space and drain the contents in conjunction with suction and irrigation. The posterolateral aspect of the superior endplate of the respective vertebra could be further drilled at this point, allowing access to the disc space with minimal retraction of the exiting nerve root. Results: Two patients underwent emergent evacuation of a ventral epidural abscess in the cervical spine using this technique. Radiographic and clinical improvement was evident after evacuation of the abscesses in both cases. Conclusions: Access to the ventral epidural space is feasible using a transpedicular approach in the cervical spine for evacuation of an epidural abscess.