Objectives: Spinal epidural abscess (SEA) is a life-threatening spinal infection with a pressing need for timely and effective surgical intervention. Conventional surgical approaches for SEA are often accompanied by extensive spinal tissue trauma and impaired spinal stability. This study retrospectively evaluates the efficacy of selective intersegmental laminectomy with irrigation (SILI), aiming to confirm that skip-level laminectomies combined with intraspinal direct irrigation can achieve effective abscess evacuation for SEA.
Methods: After ethics committee approval and patient consent, the authors studied patients with ≥ 3 affected segments and neurological deficits who had SILI from March 2020 to July 2024. Patients who had conventional continuous multisegmental laminectomy with drainage (CMLD) at the same time were controls. Inflammatory markers (WBC, CRP, ESR) were analyzed. MRI results were used to see changes in abscess volume and dura mater sac area. SILI's effect on neurological function was evaluated with 3, 6, and 12 months following up using JOA score, VAS, and modified MacNab criteria. Parametric tests (paired/independent t-test, repeated-measures ANOVA) were for normal data, nonparametric (Friedman test, Mann–Whitney U test, Chi-square test) for nonnormal and categorical data, with p < 0.05 for significance.
Results: All procedures were completed successfully without major complications. Significant improvements were observed across all outcome domains: inflammatory markers demonstrated substantial reductions, with WBC count decreasing from 13.44 ± 2.38 to 8.56 ± 2.26 × 109/L (p < 0.001), C-reactive protein declining from 80.11 ± 21.43 mg/L to 21.18 ± 9.7 mg/L (p < 0.001), and erythrocyte sedimentation rate falling from 93.55 ± 21.75 mm/h to 29.74 ± 9.21 mm/h (p < 0.001). Radiographically, MRI measurements revealed a significant reduction in abscess axial area and abscess volume, alongside effective dural sac area expansion (p < 0.001). Functionally, both JOA scores and pain VAS scores showed statistically significant improvement (p < 0.001). Modified MacNab criteria documented a clinically meaningful increase in “Excellent rate” outcomes from 55.56% at 3 months to 91.67% at 12 months postoperatively (p < 0.001). Interestingly, the SILI technique produced better results in terms of JOA scores at 6 and 12 months postoperatively, as well as in terms of the Modified MacNab criteria at 12 months, compared to the CMLD group.
Conclusions: Through strategic laminectomy site selection, SILI achieves effective evacuation of epidural abscesses via hydrodynamic bidirectional irrigation, enabling sufficient intraspinal debridement. This approach significantly reduces inflammatory markers and improves neurological function postoperatively.
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2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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