Cupler Zachary A, Anderson Michael T, Stancik Thomas J
Physical Medicine & Rehabilitative Services, VA Butler Healthcare, Butler, Pennsylvania.
Primary Care, VA Butler Healthcare, Butler, Pennsylvania.
J Chiropr Med. 2017 Sep;16(3):246-251. doi: 10.1016/j.jcm.2017.03.002. Epub 2017 Sep 19.
The purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center.
An afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment.
The veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks.
A Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess.
本病例研究的目的是描述一名海军退伍军人胸椎硬膜外脓肿的鉴别诊断，该患者前往退伍军人事务医疗中心的一家整脊诊所，接受针灸评估和治疗。
一名59岁无发热的男性，有急性胸椎疼痛和慢性下背部疼痛，前往退伍军人事务医疗中心的整脊诊所考虑接受针灸治疗。
该退伍军人选择每周进行一次针灸治疗，共4周。在患者接受保守治疗2周后疼痛未减轻50%的情况下，常规胸椎磁共振成像扫描（未使用钆剂）发现了一个占位性病变。患者被诊断为多节段胸椎椎间盘炎硬膜外脓肿，并于当天接受了T7 - 8紧急清创和椎板切除术以及T6 - 9融合术。患者完全康复，无神经功能损害，并完成了为期6周的抗生素治疗。
一名患有急性胸椎疼痛和慢性下背部疼痛的海军退伍军人最初似乎有反应，但未取得具有临床意义的结果。后续的高级影像学检查发现了胸椎椎间盘炎硬膜外脓肿。早期诊断和立即干预对于保留神经功能以及限制椎间盘炎硬膜外脓肿病例的发病率至关重要。
