Ma C C, Wang Z Y, Lin G Z
Department of Neurosurgery, Peking University Third Hospital, Beijing, 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Apr 18;52(2):275-280. doi: 10.19723/j.issn.1671-167X.2020.02.013.
To summarize the feature and treatment of the primary intraspinal abscess in order to improve the prognosis.
In the study, 13 cases of primary intraspinal abscess of the recent 20 years were retrospectively analyzed. The history, etiology, pathogen, surgical methods and prognosis were summarized.
The course of the illness ranged from 7 days to 6 months. All the cases began with pain. Of the 13 patients, 10 had limb weakness. Five had a fever and 8 had increased white blood cells. As for distribution, 1 was in cervical vertebra, 1 in cervicothoracic junction, 1 in thoracic vertebra, 4 in thoracolumbar junction, and 6 in lumbosacral segment. The results of bacterial culture were positive in 4 cases, 3 cases were diagnosed as tuberculosis by pathological examination, and 1 case was recognized as infection of Brucella melitensis bacteria because of prior brucellosis. The pathogen of the remaining cases were unclear. All the cases received surgical treatment and pathology examination. The surgical aim was mainly removal of the lesion, decompression and drainage. Postoperatively anti-infection and glucocorticoid therapy were performed according to the pathogeny results and clinical experience. Incision abscesses were seen in 2 cases and reoperations including debridement and repair with transferred muscle flap were performed. Postoperative follow-up ranged from 6 months to 3 years (mean 1.8 years). One case suffered postoperative recurrence and the abscess spread along the vertebral canal. Reoperation was performed. Infections of all the cases were recovered completely and the nervous system signs were all improved in different degrees.
The onset of primary intraspinal abscess is relatively urgent, mainly with pain. The lumbar and sacral vertebra is the predilection site. The bacterial culture is mostly negative. Early operation and use of sufficient amount of broad-spectrum antibiotic are recommended. If the incision abscess forms after the operation, it is advisable to transfer the muscle flap to repair the coloboma on the basis of debridement. In order to relieve edema of spinal cord and nerve root, the glucocorticoid can be used in the escort of antibiotics.
总结原发性脊柱内脓肿的特点及治疗方法，以改善预后。
回顾性分析近20年收治的13例原发性脊柱内脓肿患者的临床资料，总结其病史、病因、病原体、手术方式及预后情况。
病程7天至6个月。均以疼痛起病，13例患者中10例出现肢体无力，5例发热，8例白细胞升高。病变部位：颈椎1例，颈胸段1例，胸椎1例，胸腰段4例，腰骶段6例。细菌培养阳性4例，病理检查确诊结核3例，1例因既往有布鲁氏菌病诊断为布鲁氏菌感染，其余病例病原体不明。全部病例均行手术治疗及病理检查，手术目的主要为清除病灶、减压引流。术后根据病原体结果及临床经验给予抗感染及糖皮质激素治疗。2例出现切口脓肿，行包括清创及转移肌瓣修补在内的再次手术。术后随访6个月至3年（平均1.8年），1例术后复发，脓肿沿椎管蔓延，再次手术。所有病例感染均完全恢复，神经系统症状均有不同程度改善。
原发性脊柱内脓肿起病较急，以疼痛为主，腰骶部为好发部位，细菌培养多为阴性。建议早期手术并使用足量广谱抗生素。术后若形成切口脓肿，宜在清创基础上转移肌瓣修补缺损。为减轻脊髓及神经根水肿，可在使用抗生素的同时应用糖皮质激素保驾护航。
