Baker A S, Ojemann R G, Swartz M N, Richardson E P
N Engl J Med. 1975 Sep 4;293(10):463-8. doi: 10.1056/NEJM197509042931001.
Thirty-nine patients with spinal epidural abscess were evaluated at the Massachusetts General Hospital between 1947 and 1974. Twenty had acute symptoms, and purulent epidural collections were present; 19 had prolonged courses, and epidural granulation tissue was observed at operation. Staphylococcus aureus was the most common etiologic agent (57 per cent), followed by streptococci (18 per cent) and gram-negative bacilli (13 per cent). The source of infection was osteomyelitis in 38 per cent of cases and bacteremia in 26 per cent. In 16 per cent epidural abscess was due to postoperative infection. The progression from spinal ache to root pain to weakness followed by paralysis continues to be characteristic of spinal epidural abscess. Although the disease is uncommon, the complications are so serious that prompt diagnosis and treatment are of paramount importance. The combination of back pain with fewer and local tenderness is an indication for cerebrospinal-fluid examination and, depending on the results, immediate performance of myelography.
1947年至1974年间，麻省总医院对39例脊柱硬膜外脓肿患者进行了评估。20例有急性症状，存在脓性硬膜外积液；19例病程较长，手术时观察到硬膜外肉芽组织。金黄色葡萄球菌是最常见的病原体（57%），其次是链球菌（18%）和革兰氏阴性杆菌（13%）。38%的病例感染源为骨髓炎，26%为菌血症。16%的硬膜外脓肿是由术后感染引起的。从脊柱疼痛发展到神经根疼痛，再到无力，随后出现瘫痪，仍然是脊柱硬膜外脓肿的特征。尽管这种疾病并不常见，但并发症非常严重，因此及时诊断和治疗至关重要。背痛伴压痛较少且局限是进行脑脊液检查的指征，并根据检查结果立即进行脊髓造影。
