Mathews Marlon S, Ospina J, Suzuki S
Department of Neurosurgery, University of California, Irvine, CA, USA.
Interv Neuroradiol. 2011 Dec;17(4):482-5. doi: 10.1177/159101991101700414. Epub 2011 Dec 16.
Lumbosacral epidural abscesses are managed either conservatively with IV antibiotics or with open surgery, particularly in the presence of acute neurological symptoms. Their location makes it difficult for image-guided interventional approaches either for biopsy or evacuation. We report the sacral hiatus and canal as a corridor for image-guided minimally invasive abscess of lumbosacral epidural abscess for aspiration. A 56-year-old man presented to the emergency department complaining of six weeks of worsening low back pain. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as an anterior epidural abscess extending from L4-5 disc space to the S2 vertebral level. Blood cultures grew out gram-positive cocci. For drainage, a 5-French micropuncture kit was utilized to access the hiatus. Under fluoroscopic guidance a microwire was then advanced along the sacral canal. An 18-gauge needle curved to approximate the contours of the sacral canal was then advanced over the guidewire. Once anatomic access was established 2 ml of thick purulent material was aspirated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image-guided aspiration of lumbosacral epidural abscesses can thus be carried out in a safe and effective manner using a sacral hiatus approach.
腰骶部硬膜外脓肿的治疗方法包括使用静脉抗生素进行保守治疗或进行开放手术，尤其是在出现急性神经症状的情况下。由于其位置特殊，无论是活检还是引流，图像引导介入方法都难以实施。我们报告将骶裂孔和骶管作为图像引导下微创抽吸腰骶部硬膜外脓肿的通道。一名56岁男性因下背部疼痛加重6周就诊于急诊科。患者腰骶部脊柱的MRI显示L5、S1椎体骨髓炎，L5-S1椎间盘炎，以及一个从L4-5椎间盘间隙延伸至S2椎体水平的前方硬膜外脓肿。血培养检出革兰氏阳性球菌。为了进行引流，使用了一个5法式微穿刺套件进入骶裂孔。在荧光透视引导下，将一根微导丝沿骶管推进。然后将一根弯曲成近似骶管轮廓的18号针沿导丝推进。一旦建立解剖通道，吸出2毫升浓稠的脓性物质。患者对该操作耐受性良好，术后未出现局灶性神经根症状。因此，使用骶裂孔方法可以安全有效地对腰骶部硬膜外脓肿进行图像引导下抽吸。
