Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2021 Jan;145:127-133. doi: 10.1016/j.wneu.2020.09.062. Epub 2020 Sep 17.
Spinal epidural abscess may require prompt surgical intervention. Ventral cervical abscesses pose a particular challenge regarding the approach for surgical evacuation. The aim of this article was to describe the technical nuances of a posterior transpedicular cervical approach for evacuation of a ventral epidural abscess.
After a standard laminectomy, a foraminotomy was performed to identify the exiting nerve root. Then the medial aspect of the pedicle below the nerve was drilled. This allowed the insertion of a dissector to reach the ventral epidural space and drain the contents in conjunction with suction and irrigation. The posterolateral aspect of the superior endplate of the respective vertebra could be further drilled at this point, allowing access to the disc space with minimal retraction of the exiting nerve root.
Two patients underwent emergent evacuation of a ventral epidural abscess in the cervical spine using this technique. Radiographic and clinical improvement was evident after evacuation of the abscesses in both cases.
Access to the ventral epidural space is feasible using a transpedicular approach in the cervical spine for evacuation of an epidural abscess.
脊髓硬膜外脓肿可能需要及时的手术干预。颈椎腹侧脓肿在手术清除方面提出了特殊的挑战。本文的目的是描述后路经椎弓根颈椎入路清除腹侧硬膜外脓肿的技术细节。
在标准椎板切除术后，进行椎间孔切开术以识别出神经根。然后在神经下方的椎弓根内侧进行钻孔。这允许插入剥离器到达腹侧硬膜外间隙，并与抽吸和冲洗一起排出内容物。此时可以进一步在相应椎体的上终板的后外侧进行钻孔，允许进入椎间盘间隙，神经根的牵开最小。
两名患者采用该技术紧急清除颈椎腹侧硬膜外脓肿。在这两种情况下，脓肿清除后影像学和临床改善均明显。
在颈椎中，使用经椎弓根入路可实现对腹侧硬膜外间隙的进入，从而可以清除硬膜外脓肿。
