Case of unilateral biportal endoscopic management of multilevel thoracic spinal epidural abscess with acute paraplegia

Background: Spinal epidural abscess (SEA) may cause rapidly progressive neurological deterioration and requires urgent decompression when severe spinal cord compression is present. Unilateral biportal endoscopy (UBE) has been increasingly applied to spinal infection, but its use for extensive thoracic SEA has rarely been reported. Case Description: A 49-year-old female with poorly controlled type 2 diabetes mellitus presented with severe thoracic back pain and the acute onset of paraplegia. Thoracic magnetic resonance demonstrated a posterior epidural abscess extending from T7 to T11 resulting in severe thoracic spinal cord compression. Urgent decompression and abscess evacuation were performed using UBE without conversion to open surgery. Postoperative imaging demonstrated near-complete evacuation of the collection, while motor strength progressively improved to Medical Research Council grade 4/5 in both lower extremities. Conclusion: UBE may provide effective decompression and abscess evacuation in carefully selected patients with multilevel posterior thoracic SEA.