Fujii Masashi, Shirakawa Tsutomu, Shime Nobuaki, Kawabata Yasuyo
Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae-cho, Nagahama, Shiga, 526-8585, Japan.
Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Nagahama, Shiga, Japan.
JA Clin Rep. 2020 Jan 15;6(1):4. doi: 10.1186/s40981-020-0309-z.
Surgical drainage and antimicrobial therapy are the most accepted empirical treatments for spinal epidural abscess. However, surgery may not be indicated when patient's general health condition is poor. Percutaneous drainage has been reported as a non-surgical treatment for children or patients with no or minor neurological deficits. Here we describe the successful treatment of an extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage in an elderly man with progressive muscle weakness who could not be operated because of a poor general health condition.
An 81-year-old man presented with fever, back pain, and progressive muscle weakness in bilateral legs. Magnetic resonance imaging (MRI) showed extensive fluid retention in the spinal epidural space (Th6 to L3). Paraplegia due to an epidural abscess was suspected. We considered an emergency operation; however, the patient's general condition was poor. Therefore, fluoroscopy-guided percutaneous epidural drainage was performed. After drainage, his back pain and muscle weakness gradually resolved. After 3 weeks, MRI showed that the abscesses had completely disappeared.
Compared with surgical drainage, fluoroscopy-guided percutaneous epidural drainage is a less invasive treatment option for patients with a poor general condition.
手术引流和抗菌治疗是脊柱硬膜外脓肿最常用的经验性治疗方法。然而，当患者一般健康状况较差时，可能不适合进行手术。经皮引流已被报道可作为儿童或无神经功能缺损或神经功能缺损轻微患者的非手术治疗方法。在此，我们描述了一名患有进行性肌肉无力的老年男性，因一般健康状况较差无法进行手术，通过透视引导下经皮引流成功治疗广泛的脊柱硬膜外脓肿的病例。
一名81岁男性，出现发热、背痛及双下肢进行性肌肉无力症状。磁共振成像（MRI）显示脊柱硬膜外间隙（胸6至腰3）广泛积液。怀疑因硬膜外脓肿导致截瘫。我们考虑进行急诊手术；然而，患者一般状况较差。因此，进行了透视引导下经皮硬膜外引流术。引流后，他的背痛和肌肉无力逐渐缓解。3周后，MRI显示脓肿已完全消失。
与手术引流相比，透视引导下经皮硬膜外引流对于一般状况较差的患者是一种侵入性较小的治疗选择。
