Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study

Adnan I. Qureshi, Mushtaq H. Qureshi, Ahmed A. Malik, Vikram Jadhav, Stanley H. Kim

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background Approaching and aspirating cervical and high thoracic epidural abscesses through a trans-epidural route from the lumbar region access represents an alternative method for selected patients. Objective We determined the feasibility of catheter-based manipulation and aspiration using the trans-epidural route. Material and Methods A custom designed infusion-suction catheter system that includes an outer suction catheter and inner infusion catheter in concentric relation with radio-opaque marker bands was tested in a cadaveric preparation to determine (1) the ability to place an aspiration catheter over a guidewire using a percutaneous approach within the posterior lumbar epidural space; (2) the highest vertebral level a catheter can be advanced within the epidural space; and (3) the ability to aspirate artificial purulent-like material placed in the cervical and thoracic level epidural space. Results We were able to advance two infusion-suction catheter systems from a 14G Touhy spinal needle inserted via an oblique parasagittal approach at the L2-L3 intervertebral space. The infusion-suction catheter was advanced up to the level of the cervical vertebral level of C2 within the epidural space under fluoroscopic guidance. We were able to aspirate artificial purulent-like material directly injected with a 22G Quincke spinal needle at vertebral levels C4-C5 and at vertebral levels T10-T11 by aspiration and manipulation of the outer catheter within the epidural space at levels C3-C7 andT9-L1, respectively. Conclusions Our observations support the further exploration of a percutaneous catheter-based trans-epidural approach to treat epidural abscesses. The trans-epidural approach may be used alone or as a staged or concurrent approach with open surgical treatment.

Original languageEnglish (US)
Pages (from-to)369-375
Number of pages7
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
Issue number5
StatePublished - Sep 1 2015

Bibliographical note

Publisher Copyright:
© 2015 Georg Thieme Verlag KG Stuttgart.


  • catheter
  • cervical vertebra
  • epidural abscess
  • microcatheter
  • thoracic vertebra


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