Hlavin M L, Kaminski H J, Ross J S, Ganz E
Division of Neurological Surgery, University Hospitals of Cleveland, Ohio.
Neurosurgery. 1990 Aug;27(2):177-84.
A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice.
对40例患者进行了一项为期10年的脊柱硬膜外脓肿回顾性研究。对流行病学、临床特征、实验室检查结果、影像学检查、治疗方法及预后进行了分析，并与以往的研究系列进行了比较。发现该病的发病率呈上升趋势（每年每10000例入院患者中达1.96例），且患者年龄更大、身体更虚弱（67%有易感染因素）。超过一半的患者接受了磁共振成像检查，发现其敏感性（91%）与脊髓造影联合计算机断层扫描（92%）相当。磁共振成像具有无创性且能清晰显示其他病变的优点，使其成为首选的成像方式。术前出现瘫痪以及神经功能从正常状态恶化被确定为不良预后特征。7例术前瘫痪的患者中，5例死亡，其余患者神经功能未能恢复。11例最初神经检查正常的患者在手术干预前在医院病情恶化。其中8例患者正在接受适当的抗生素治疗；2例患者尽管接受了超过3周的抗生素治疗仍出现瘫痪。这11例患者中只有3例完全康复。立即进行手术减压并联合使用抗生素仍然是首选的治疗方法。
