Wetherington Brian, Khan Talal W
Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.
Pain Pract. 2019 Jan;19(1):57-60. doi: 10.1111/papr.12691. Epub 2018 Apr 19.
Spinal cord stimulation (SCS) can be beneficial for low back and radicular pain. A short trial of SCS evaluates the potential effectiveness of this therapy for a specific patient, while also decreasing the likelihood of a failed permanent implant. While rare, an epidural abscess is difficult to diagnose based on its nonspecific and unreliable clinical presentation.
We present a case of an acute-onset methicillin-sensitive Staphylococcus aureus epidural abscess 72 to 96 hours into a trial of a percutaneous spinal cord stimulator. The patient had no prior medical history of an immunocompromised state or other significant risk factors.
An epidural abscess can rapidly arise from an SCS trial despite strict aseptic technique and prophylactic pre-procedural antibiotics. Spinal epidural abscesses are being detected earlier, and an increasing number of patients are being managed medically. However, it may be challenging to differentiate focal back pain from acute or chronic pain, expected post-procedural pain, and a new entity such as an abscess.
脊髓刺激（SCS）对腰背痛和神经根性疼痛可能有益。SCS短期试验可评估该疗法对特定患者的潜在有效性，同时也降低永久性植入失败的可能性。硬膜外脓肿虽罕见，但因其临床表现不具特异性且不可靠，故难以诊断。
我们报告一例在经皮脊髓刺激器试验72至96小时后发生急性起病的甲氧西林敏感金黄色葡萄球菌硬膜外脓肿病例。该患者既往无免疫功能低下状态或其他重大危险因素的病史。
尽管采用了严格的无菌技术和术前预防性使用抗生素，但SCS试验仍可能迅速引发硬膜外脓肿。脊髓硬膜外脓肿的诊断越来越早，且越来越多的患者接受药物治疗。然而，将局部背痛与急性或慢性疼痛、预期的术后疼痛以及诸如脓肿等新情况区分开来可能具有挑战性。
