Löhr M, Reithmeier T, Ernestus R-I, Ebel H, Klug N
Department of Neurosurgery, University of Cologne, Cologne, Germany.
Acta Neurochir (Wien). 2005 Feb;147(2):159-66; discussion 166. doi: 10.1007/s00701-004-0414-1.
Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment. The standard approach to decompress SEA is laminectomy. No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage.
A retrospective evaluation of the medical and radiological data was undertaken in 27 consecutive patients with SEA operated on during a period of 10 years by a dorsal approach. Factors influencing outcome were evaluated with special regard to different surgical strategies concerning the invasiveness of the operative approach, the use of intra-operative ultrasound and the use of different drainage systems.
Outcome was mainly determined by the pre-operative neurological condition and the localization of the abscess. Recurrence rate was dependent on the longitudinal extent of the mass and the intra-operative finding of granulation tissue, but not on the administration of a postoperative suction-irrigation drainage. An interlaminar approach was equally matched to a decompression by laminectomy in lumbar SEA concerning the incidence of residual/recurrent abscess formation. In concomitant spondylodiscitis, laminectomy bore the risk of the formation of a postoperative kyphotic deformity. The use of intra-operative ultrasound allowed the visualization of hidden inflammatory masses and, thus, reduced the rate of residual abscess formation.
An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.
脊柱硬膜外脓肿（SEA）是一种罕见但可能具有毁灭性的疾病，需要立即进行手术干预和适当的抗生素治疗。减压SEA的标准方法是椎板切除术。目前尚无报告全面涵盖微创椎间孔入路的适应症、术中超声的作用以及插入吸引冲洗引流管的潜在益处。
对连续27例在10年期间接受后路手术的SEA患者的医学和放射学数据进行回顾性评估。特别针对手术入路的侵袭性、术中超声的使用以及不同引流系统的使用等不同手术策略，评估影响预后的因素。
预后主要取决于术前神经功能状态和脓肿的位置。复发率取决于肿块的纵向范围和术中肉芽组织的发现，但与术后吸引冲洗引流的应用无关。在腰椎SEA中，就残余/复发性脓肿形成的发生率而言，椎间孔入路与椎板切除术减压效果相当。在合并脊椎椎间盘炎时，椎板切除术有术后脊柱后凸畸形形成的风险。术中超声的使用能够显示隐匿的炎性肿块，从而降低残余脓肿形成的发生率。
对于腰椎SEA以及因脊柱炎导致前路柱即将不稳的情况，应考虑采用椎间孔入路而非椎板切除术。术中超声有助于确定手术中的减压范围，即使通过狭窄的椎间孔骨窗也切实可行。术后插入吸引冲洗引流管对预后无有益影响，但有硬膜外积液充血的风险。
