Akhaddar Ali, Baallal Hassan, Elktaibi Abderrahim
Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University in Rabat, Rabat, Morocco.
Department of Histopathology, Avicenne Military Hospital of Marrakech, Mohammed V University in Rabat, Rabat, Morocco.
Surg Neurol Int. 2018 Apr 5;9:70. doi: 10.4103/sni.sni_64_18. eCollection 2018.
Surgical site infections following spinal surgery, including spinal abscesses, are rare but serious as they are major causes of morbidity, and even mortality. They are, however, rarely attributed to infected, retained surgical cottonoids or sponges (textiloma or gossypiboma) inadvertently left in an operative field.
A 53-year-old female with a history of two prior spinal operations at the L4-S1 levels (11 and 2 years previously) presented over a few weeks with the acute onset of a cauda equina syndrome (e.g., paraparesis and acute urinary incontinence). The patient demonstrated a mildly elevated white blood cell count (12,600/mm) and abnormally increased C-reactive protein level that correlated with the magnetic resonance imaging that showed a dorsal epidural abscess extending from the L4 to S1 levels. At surgery, an encapsulated posterior epidural abscess was drained. Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid and was removed from the antero-inferior portion of the abscess wall at S1. Culture of the thick fibrotic abscess wall grew . After 2 months of ciprofloxacin, the patient's infection cleared but the motor deficit only partially resolved.
Most spinal textilomas (gossypibomas) are aseptic and are found in paraspinal areas without neurological symptoms or sequelae. These lesions may remain silent for years and may only rarely cause neurologic or infectious symptoms/signs. Notably, textilomas following spinal surgery may be largely avoided if proper cottonoid and sponge counts are done prior to closing spinal wounds.
脊柱手术后的手术部位感染，包括脊柱脓肿，虽罕见但严重，因为它们是发病甚至死亡的主要原因。然而，它们很少归因于手术中不慎遗留在手术区域的受感染、残留的手术棉片或海绵（纺织瘤或棉绒瘤）。
一名53岁女性，既往有两次L4 - S1节段脊柱手术史（分别在11年和2年前），在几周内出现马尾综合征急性发作（如双下肢轻瘫和急性尿失禁）。患者白细胞计数轻度升高（12,600/mm），C反应蛋白水平异常升高，这与磁共振成像结果相符，该成像显示一个从L4延伸至S1节段的背侧硬膜外脓肿。手术中，一个有包膜的后硬膜外脓肿被引流。手术发现包括一个与残留手术棉片一致的肉芽肿性病变，并从S1节段脓肿壁的前下部取出。厚纤维化脓肿壁的培养结果为……。使用环丙沙星治疗2个月后，患者的感染得到清除，但运动功能障碍仅部分缓解。
大多数脊柱纺织瘤（棉绒瘤）是无菌的，位于椎旁区域，无神经症状或后遗症。这些病变可能多年无症状，仅极少数情况下会引起神经或感染症状/体征。值得注意的是，如果在关闭脊柱伤口前对棉片和海绵进行正确计数，很大程度上可以避免脊柱手术后的纺织瘤。
