Pediatric Department, Venizeleio General Hospital, Crete, Greece.
Radiology Department, Venizeleio General Hospital, Crete, Greece.
Acta Paediatr. 2019 Jan;108(1):28-36. doi: 10.1111/apa.14579. Epub 2018 Oct 15.
A spinal epidural abscess (SEA) is a rare paediatric bacterial infection, with possible devastating neurological sequelae. We explored localisation in the cervical segment, which is unusual, but more dangerous, than other SEAs.
We describe 22 cases (12 male) of paediatric SEAs without risk factors: 21 from a literature search from 2000 to 2017 and a 30-month-old boy with a spontaneous cervical SEA due to Group A Streptococcus.
The average age was eight years and the symptoms were mainly fever, back pain and motor deficit, with an aetiological diagnosis in 68%. Methicillin-sensitive Staphylococcus aureus was isolated in six patients, methicillin-resistant Staphylococcus aureus in two, Staphylococcus aureus with unknown susceptibility patterns in three and Group A Streptococcus in four. All patients underwent gadolinium-enhanced magnetic resonance imaging and most abscesses were localised in the thoracic and lumbar areas. More than half (59%) underwent surgery to remove pus and granulation tissue and nine were just treated with antimicrobial therapy for an average of 5.3 weeks. Most patients had good outcomes.
SEAs were underestimated in children due to the rarity and spectrum of differential diagnoses. Timely diagnosis, immediate antibiotics, spinal magnetic resonance imaging and prompt neurosurgical consultations were essential for favourable outcomes.
硬脊膜外脓肿（SEA）是一种罕见的小儿细菌性感染，可能导致严重的神经后遗症。我们探讨了颈椎段的定位，这比其他 SEA 更不常见，但也更危险。
我们描述了 22 例（男 12 例）无危险因素的小儿 SEA 病例：21 例来自 2000 年至 2017 年的文献检索，1 例 30 个月大的男孩因 A 组链球菌引起自发性颈椎 SEA。
平均年龄为 8 岁，主要症状为发热、背痛和运动障碍，病因诊断率为 68%。6 例患者分离出甲氧西林敏感金黄色葡萄球菌，2 例分离出耐甲氧西林金黄色葡萄球菌，3 例金黄色葡萄球菌对药物敏感模式未知，4 例分离出 A 组链球菌。所有患者均行钆增强磁共振成像检查，大部分脓肿位于胸腰椎区。超过一半（59%）的患者接受了手术以清除脓液和肉芽组织，9 例仅接受了抗菌治疗，平均治疗 5.3 周。大多数患者预后良好。
由于 SEA 的罕见性和鉴别诊断的范围，在儿童中容易被低估。及时的诊断、立即使用抗生素、脊髓磁共振成像和及时的神经外科会诊对良好的预后至关重要。
