40例颈椎硬膜外脓肿患者的手术治疗：向环形治疗转变
Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.
作者信息
Ghobrial George M, Viereck Matthew J, Margiotta Philip J, Beygi Sara, Maulucci Christopher M, Heller Joshua E, Vaccaro Alexander R, Harrop James S
机构信息
*Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA †Department of Neurological Surgery, Tulane University, New Orleans, LA; and ‡Department of Orthopedic Surgery, The Rothman Institute, Philadelphia, PA.
出版信息
Spine (Phila Pa 1976). 2015 Sep 1;40(17):E949-53. doi: 10.1097/BRS.0000000000000942.
STUDY DESIGN
Retrospective database review of a prospectively maintained neurosurgical database.
OBJECTIVE
The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization.
SUMMARY OF BACKGROUND DATA
CSEA management is guided by small case series.
METHODS
A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded.
RESULTS
Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients.
CONCLUSIONS
In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate.
LEVEL OF EVIDENCE
研究设计
对前瞻性维护的神经外科数据库进行回顾性数据库分析。
目的
回顾颈椎硬膜外脓肿（CSEA）的手术治疗，探讨从单次前后路减压及固定手术向分期手术的转变。
背景资料总结
CSEA的治疗以小样本病例系列为指导。
方法
对1997年至2011年诊断标题为颈椎硬膜外脓肿、感染、骨髓炎、骨椎间盘炎、脊椎间盘炎和脓肿的患者进行回顾性分析。记录合并症、危险因素、手术方式、神经功能分级及预后。
结果
在1997年至2010年的手术数据库中，连续确定了40例CSEA患者（平均年龄53岁，年龄范围23 - 74岁，标准差±14，女性10例）。21例患者体重指数超过25（53%），6例（15%）患有糖尿病，6例（15%）曾患恶性肿瘤，其中2例曾接受颈部放疗，9例（23%）使用烟草制品。与CSEA相关的最常见危险因素是静脉药物滥用，见于10例患者（25%）。椎间盘炎最常累及的节段是C6 - C7，共12例（30%），其次是C5 - C6椎间盘，共11例（28%），最少累及的是C1 - C2节段，共2例（5%）和C7 - T1节段，共2例（5%）。就诊时最常见的神经功能分级是美国脊髓损伤协会（AIS）D级，共20例（50%），其次是AIS E级，共9例（28%）。所有患者均接受磁共振成像检查，发现17例（43%）为背侧硬膜外脓肿，12例（30%）为腹侧脓肿，11例（28%）为环形硬膜外脓肿。大多数患者先接受前路减压及固定，然后接受后路减压及固定（n = 26，65%）；8例（20%）接受了前路手术，6例接受了后路手术（15%）。40例中有39例（97.5%）实现了融合，且在1个患者中使用头环固定未受显著影响。
结论
在本系列研究中，患者接受了急性脓肿清除和脊髓减压手术，向分期治疗的转变并未导致围手术期并发症发生率增加。
证据等级
3级
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