Hanifah J, Joehaimey J, Yusof M I
Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malays Orthop J. 2017 Jul;11(2):85-88. doi: 10.5704/MOJ.1707.018.
Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed , suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation the 4 post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.
脊髓硬膜外脓肿是一种严重的、通常为化脓性的脊髓或马尾硬膜外间隙感染。脓肿引起的肿胀会导致神经结构受压或血管破坏，这需要紧急手术减压以避免严重的永久性残疾。我们分享一例罕见的因既往肺部感染血行播散继发的脊髓硬膜外脓肿病例，该病例在我们中心就诊时已出现马尾综合征且就诊较晚，但延迟减压后显示出良好的短期预后。一名50岁女性，有持续一周的下腰痛病史，双侧下肢无力逐渐加重7天，伴有2天的尿潴留及鞍区感觉缺失。腰骶部增强磁共振成像显示左侧臀大肌和左侧多裂肌内有脓肿形成，L3 - L5水平后方硬膜外病变在增强扫描时周边强化，提示硬膜外脓肿压迫马尾。采用后路腰椎手术引流脓液。组织和脓液培养结果显示……提示细菌感染。术后患者双下肢肌力立即改善，术后第4天恢复了排尿和排便控制能力。马尾综合征延迟减压后有良好的短期预后极为罕见。尽管减压延迟超过48小时，但积极的手术减压联合抗生素治疗使该患者获得了良好的短期预后。
