Perez-Toro Marco R, Burton Allen W, Hamid Basem, Koyyalagunta Dhanalakshmi
University of Texas-MD Anderson Cancer Center, Houston, TX 77004, USA.
Pain Med. 2009 Apr;10(3):501-5. doi: 10.1111/j.1526-4637.2008.00552.x. Epub 2009 Jan 16.
The incidence of spinal epidural abscess has increased in the past decades. Traditionally, management was based on surgical decompression. More recent studies have shown conservative management has successful outcomes in selected patients.
We present a case, in which an elderly woman presented with new onset radicular pain and mild leukocytosis more than a week after a complicated revision of an intrathecal catheter in place for management of chronic axial low back pain. Magentic resonance imaging (MRI) revealed a posterior epidural abscess from T12 to L2. Two Touhy needles were placed in the epidural space with fluoroscopic guidance for drainage of the abscess. A catheter was then advanced into the epidural space for irrigation with saline and an antibiotic solution. Intravenous antibiotics were continued for a total of 6 weeks. Radicular pain resolved immediately post-procedure. Serial MRIs also showed decreasing size of the abscess.
Posterior spinal epidural abscesses may be successfully treated by way of the two Touhy needle and catheter technique for drainage and irrigation. This procedure should be reserved for patients that present with no neurological deficits or deemed nonsurgical candidates. Patients should continue on prolonged intravenous antibiotics and be monitored closely for clinical deterioration and undergo serial follow-up MRIs.
在过去几十年中，脊柱硬膜外脓肿的发病率有所上升。传统上，治疗方法是手术减压。最近的研究表明，在特定患者中，保守治疗也能取得成功。
我们报告一例，一名老年女性在为治疗慢性轴性腰痛而置入的鞘内导管进行复杂翻修术后一周多，出现新发神经根性疼痛和轻度白细胞增多。磁共振成像（MRI）显示胸12至腰2水平有一个硬膜外脓肿。在透视引导下，将两根Tuohy针置入硬膜外间隙以引流脓肿。然后将一根导管推进硬膜外间隙，用生理盐水和抗生素溶液进行冲洗。静脉使用抗生素共持续6周。术后神经根性疼痛立即缓解。系列MRI检查也显示脓肿体积缩小。
脊柱后硬膜外脓肿可通过两根Tuohy针和导管技术进行引流和冲洗而成功治疗。该方法应仅用于无神经功能缺损或被认为不适合手术的患者。患者应继续长期静脉使用抗生素，并密切监测临床病情恶化情况，同时接受系列随访MRI检查。
