Ramhmdani Seba, Bydon Ali
The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Spine Surg. 2017 Jun;3(2):243-249. doi: 10.21037/jss.2017.05.04.
Spinal epidural abscess (SEA) following dental procedures is a rarely reported entity. Here, we present a unique case of a 74-year-old immunocompetent man who developed severe lower back pain and bilateral lower extremity weakness 4 days following two root canal procedures. Lumbar spine magnetic resonance imaging (MRI) showed several pockets of epidural abscesses extending from L1 through L5. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated with IV penicillin for 7 days but his symptoms continued to deteriorate. A repeat MRI showed extension of the epidural abscess to T10-T11 level. The patient was emergently transferred to our hospital where he underwent bilateral decompressive laminectomy of T10 through S1 and abscess evacuation. Pus culture was positive for Streptococcus intermedius, which confirmed the diagnosis and the treatment plan. He was discharged on intravenous (IV) penicillin for 6 weeks. His symptoms improved significantly postoperatively as he retained his baseline strength in his lower extremity.
牙科手术后发生的脊柱硬膜外脓肿（SEA）是一种鲜有报道的病症。在此，我们报告一例独特病例，一名74岁免疫功能正常的男性，在接受两次根管治疗术后4天出现严重的下背部疼痛和双侧下肢无力。腰椎磁共振成像（MRI）显示多个硬膜外脓肿腔，从L1延伸至L5。血培养生长出中间型链球菌，这是口腔和上呼吸道正常菌群中的一种厌氧共生菌。患者接受了7天的静脉注射青霉素治疗，但症状持续恶化。复查MRI显示硬膜外脓肿扩展至T10 - T11水平。患者紧急转至我院，在我院接受了T10至S1的双侧减压椎板切除术及脓肿引流。脓液培养中间型链球菌呈阳性，这证实了诊断并确定了治疗方案。他出院时接受了6周的静脉注射青霉素治疗。术后他的症状明显改善，下肢保留了基线肌力。
