Shah Akash A, Yang Huiliang, Harris Mitchel B, Schwab Joseph H
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
Clin Spine Surg. 2019 Apr;32(3):E126-E132. doi: 10.1097/BSD.0000000000000746.
This was a retrospective case-control study.
We aim to describe a novel 5-point grading system to determine the degree and severity of spinal cord compression secondary to a spinal epidural abscess (SEA). Secondarily, we aim to correlate the degree of compression with clinical presentation and outcomes.
Mechanical compression plays an important role in the pathophysiology of neurological dysfunction in SEA. Unfortunately, no standardized classification system for describing the degree of spinal cord compression exists. The lack of a validated grading system makes it challenging to study and consistently report the relationship between cord compression and clinical presentation/outcomes in SEA.
Patients 18 years and older admitted to our hospital system with a diagnosis of SEA located above the conus medullaris between 1993 and 2016 were included. Using pretreatment axial magnetic resonance images, we developed a 5-point classification scale to determine the degree of spinal cord compression. After assigning a compression grade to each abscess, we investigated the relationship between the degree of compression and presenting neurological symptoms. Furthermore, we assessed the association between compression grade and clinical outcomes.
Three hundred thirty-nine patients were included in the study. Patients with high-grade cord compression (grades 4 and 5) were significantly more likely to present with pretreatment motor deficit, sensory changes, and bowel/bladder incontinence. With respect to clinical outcomes, increasing degree of compression was not associated with failure of nonoperative management, residual motor deficit, or 90-day mortality.
We report a novel grading system for spinal cord compression in SEA with 5 progressively increasing grades of compression. High-grade abscesses with cord compression were significantly associated with neurological deficit at presentation but not with poor outcomes. We hope that this classification system will allow for greater consistency in reporting the association between cord compression and neurological deficit in SEA.
这是一项回顾性病例对照研究。
我们旨在描述一种新的5分分级系统，以确定继发于脊髓硬膜外脓肿（SEA）的脊髓压迫程度和严重程度。其次，我们旨在将压迫程度与临床表现及预后相关联。
机械性压迫在SEA所致神经功能障碍的病理生理学中起重要作用。不幸的是，目前尚无用于描述脊髓压迫程度的标准化分类系统。缺乏经过验证的分级系统使得研究并持续报告SEA中脊髓压迫与临床表现/预后之间的关系具有挑战性。
纳入1993年至2016年间我院系统收治的18岁及以上、诊断为脊髓圆锥以上SEA的患者。利用治疗前的轴向磁共振图像，我们制定了一个5分分类量表来确定脊髓压迫程度。在为每个脓肿指定压迫等级后，我们研究了压迫程度与所呈现的神经症状之间的关系。此外，我们评估了压迫等级与临床预后之间的关联。
339例患者纳入研究。脊髓高度压迫（4级和5级）的患者在治疗前出现运动功能缺损、感觉改变和大小便失禁的可能性显著更高。关于临床预后，压迫程度增加与非手术治疗失败、残留运动功能缺损或90天死亡率无关。
我们报告了一种用于SEA中脊髓压迫的新分级系统，压迫等级分为5级，逐级递增。伴有脊髓压迫的高度脓肿在就诊时与神经功能缺损显著相关，但与不良预后无关。我们希望这个分类系统将使SEA中脊髓压迫与神经功能缺损之间关联的报告更加一致。
