Medical University of Plovdiv, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 2020 Sep 30;62(3):482-489. doi: 10.3897/folmed.62.e49902.
Spinal epidural abscess is uncommon but potentially debilitating infection. Delay in early diagnosis may be associated with increased morbidity and mortality despite recent advances in medicine.
To present the clinical course and outcome of treatment of spontaneous spinal epidural abscesses.
Thirty-four patients (20 men and 14 women) with clinical, neuroimaging and/or histological data for spinal epidural abscess were treated at the Clinic of Neurosurgery at St George University Hospital, Plovdiv, Bulgaria, for the period 2009-2018.
The average age of patients was 62 years (21-76 years) and the ratio of men to women was 1.4:1. All patients (100%) presented with vertebralgia, 13 patients (38.2%) had additional radiculalgia, and 10 patients (29.4%) presented with sensory or motor deficit. The duration of complaints varied from 4 to 180 days. At hospital admission, only 9 patients (26.4%) had intact neurological status. The most common localization of the spinal epidural abscess was in the lumbar and lumbosacral area (52.9%), concomitant spondylodiscitis was present in 31 patients (91.2%). Twenty-four patients (70.6%) underwent emergency surgery within 24 hours, and the rest had planned surgery. Decompressive interlaminotomy or hemilaminectomy was performed in 9 patients (26.5%). The remaining 25 patients (73.5%) underwent laminectomy, in 15 patients (44.1%) it was combined with posterior pedicle screw fixation. After the treatment, 23 patients (67.6%) had a good outcome, the remaining 11 (32.4%) had a poor outcome, and 3 patients died (8.8%).
In patients with spinal epidural abscess, emergency surgery is the treatment method of choice. It allows decompression of neural structures, correction of the spinal deformity, segmental stabilization and rapid mobilization of patients.
脊髓硬膜外脓肿并不常见，但具有潜在的致残性。尽管医学取得了最新进展，但早期诊断的延误可能与发病率和死亡率的增加有关。
介绍自发性脊髓硬膜外脓肿的临床病程和治疗结果。
2009 年至 2018 年期间，保加利亚普罗夫迪夫圣乔治大学医院神经外科诊所治疗了 34 例（20 名男性和 14 名女性）具有脊髓硬膜外脓肿临床、神经影像学和/或组织学数据的患者。
患者平均年龄为 62 岁（21-76 岁），男女比例为 1.4:1。所有患者（100%）均表现为脊椎痛，13 例（38.2%）伴有神经根痛，10 例（29.4%）伴有感觉或运动障碍。症状持续时间从 4 天至 180 天不等。入院时，只有 9 例（26.4%）患者的神经功能完整。脊髓硬膜外脓肿最常见的部位是腰椎和腰骶部（52.9%），31 例（91.2%）同时存在脊椎炎。24 例（70.6%）患者在 24 小时内接受急诊手术，其余患者接受择期手术。9 例（26.5%）患者行减压椎板间切开术或半椎板切除术，其余 25 例（73.5%）行椎板切除术，其中 15 例（44.1%）联合后路椎弓根螺钉固定。治疗后，23 例（67.6%）患者预后良好，11 例（32.4%）患者预后不良，3 例患者死亡（8.8%）。
在脊髓硬膜外脓肿患者中，急诊手术是首选的治疗方法。它可以实现神经结构减压、脊柱畸形矫正、节段稳定和患者快速活动。
