Minimally Invasive Multilevel Decompression and Irrigation for Holospinal Subdural Abscess: A Case Report

Holospinal subdural abscess is an extremely rare but potentially devastating condition that requires prompt diagnosis and targeted management. We report the case of a 54-year-old man with no history of trauma, comorbidities, or previous spinal procedures who presented with progressive back pain and weakness. Magnetic resonance imaging revealed an extensive subdural collection extending from the cervical to the sacral level, causing anterior compression of the spinal cord. The patient underwent a minimally invasive skip-laminectomy approach that avoided wide decompression. Through limited multilevel exposures, subdural drainage and irrigation were performed using an external ventricular drainage catheter, achieving effective decompression with minimal tissue disruption. Staphylococcus aureus was identified on culture. The patient achieved complete neurological recovery following targeted antibiotic therapy and postoperative subdural irrigation. This case demonstrates that carefully planned, minimally invasive multilevel drainage can effectively manage even extensive holospinal infections while preserving spinal stability. Early recognition using magnetic resonance imaging and individualized, limited decompression are crucial to prevent irreversible neurological deficits.