Lee Jun-Seok, Ryu Ji-Hyun, Park Jong-Tae, Kim Ki-Won
Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Republic of Korea.
BMC Musculoskelet Disord. 2017 Jan 10;18(1):11. doi: 10.1186/s12891-016-1360-9.
Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA.
A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently.
Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.
破坏性脊椎关节病（DSA）是长期血液透析患者的主要并发症之一。据我们所知，文献中尚未对在先前存在的颈椎DSA水平发生的硬膜外脓肿进行充分描述。我们报告了一例由在先前存在的颈椎DSA相同水平发生的硬膜外脓肿导致四肢瘫痪的独特病例。
一名49岁女性因败血症5天、精神状态嗜睡和C5水平以下四肢瘫痪被转入我们的急诊科。该患者有10年血液透析病史。磁共振成像显示在先前存在的颈椎DSA水平有硬膜外脓肿压迫脊髓。血培养显示对甲氧西林敏感的金黄色葡萄球菌。动静脉（AV）分流感染被认为是败血症和化脓性脊柱炎的主要病灶。我们进行了紧急开门式椎板成形术，血管团队对感染的AV分流部位进行了清创。术后约8个月，患者能够在一定程度上独立进行日常生活活动。
紧急手术减压和强化医疗护理使该患者从败血症和四肢瘫痪状态成功康复。在诊断长期血液透析且出现神经功能缺损的患者时，应考虑与DSA同一水平发生感染性脊柱炎的可能性。
