Fang Wen-Kuei, Chen Shih-Han, Huang Da-Wei, Huang Kuo-Chang
Department of Neurosurgery, Chiayi Christian Hospital, Chiayi, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Apr;72(4):210-3. doi: 10.1016/S1726-4901(09)70057-7.
Spinal osteomyelitis with epidural abscess is a rare disease. Most patients have 1 or more predisposing factors, such as impaired immune system secondary to diabetes mellitus, chemotherapy for cancer, immunological compromised disease, and chronic renal or hepatic impairment. We present a case of a physically steady young man without any predisposing risk factor who suffered from cervical osteomyelitis with epidural abscess after neck blunt injury. This patient recovered well after one-stage anterior surgical debridement with implant instrumentation and proper antibiotics treatment. The initial accurate diagnosis rate of spinal epidural abscess is low, even in patients with predisposing factor(s). We present this case to raise the attention of medical staff to this disease in patients with or without any predisposing factor(s) in order to establish early diagnosis and treatment. Our case report also indicates that with adequate debridement and antibiotic coverage, one-stage surgery is a safe and efficacious method to treat patients with cervical spinal epidural abscess.
伴有硬膜外脓肿的脊柱骨髓炎是一种罕见疾病。大多数患者有1种或更多易感因素,如继发于糖尿病的免疫系统受损、癌症化疗、免疫功能低下疾病以及慢性肾或肝功能损害。我们报告一例身体状况稳定的年轻男性,他没有任何易感风险因素,在颈部钝器伤后发生了伴有硬膜外脓肿的颈椎骨髓炎。该患者在接受一期前路手术清创、植入内固定器械并给予适当抗生素治疗后恢复良好。脊柱硬膜外脓肿的初始准确诊断率较低,即使是有易感因素的患者。我们报告此病例是为了提高医护人员对有或没有任何易感因素患者的这种疾病的关注,以便早期诊断和治疗。我们的病例报告还表明,通过充分的清创和抗生素覆盖,一期手术是治疗颈椎硬膜外脓肿患者的一种安全有效的方法。