Killen Maire-Clare, Hernandez Miguel, Berg Andrew, Bhatia Chandra
Spinal Unit, University Hospital of North Tees, Stockton-on-Tees.
Pennine Acute NHS Trust.
Int J Spine Surg. 2015 Sep 17;9:47. doi: 10.14444/2047. eCollection 2015.
Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised. Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature. Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality. Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities. We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery.
脊柱硬膜外脓肿并不常见，但发病率正在上升。它们是硬膜外间隙脓性物质的积聚，最常发生在腰椎，且局限于该部位。累及所有三个脊柱节段的脓肿（全脊柱或多节段脓肿）极为罕见，文献中仅报道了少数病例。硬膜外脓肿是特别高危的感染，因为可能迅速出现进行性神经功能障碍；因此，早期诊断和治疗对于避免长期神经并发症和降低潜在死亡率至关重要。鉴于这种疾病的罕见性，其治疗仍存在争议，对于保守治疗与手术治疗尚无明确的指导意见。文献大多建议对有神经异常的患者进行手术减压并联合静脉使用抗生素。我们描述了一例77岁患者，该患者多节段硬膜外脓肿诊断延迟，并伴有上运动神经元体征。该患者通过一个疗程的抗生素治疗成功获得非手术治愈，脓肿在影像学上完全消退，神经功能完全恢复。
