Roberti Fabio
Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA.
Department of Neurological Surgery, The George Washington University, Washington DC, USA.
J Spine Surg. 2020 Dec;6(4):729-735. doi: 10.21037/jss-20-603.
Spinal abscesses that involve the full length of the spine, from the cervical to the sacral regions, are rare and account for approximately 1% of spinal epidural infections. Urgent surgical decompression combined with antibiotics treatment is usually recommended in these patients and selection of the most suitable surgical approach is tailored on the extent and location of the fluid collection. We present a rare case of holocord spinal epidural abscess treated with cervico-thoracic-lumbar tandem tubular decompressive laminectomies with alternating incisions, which were tailored on the preoperative sagittal and axial extension of the abscess. This minimally invasive procedure allowed for the successful drainage and decompression of the epidural space in an adult patient presenting with acute worsening tetraparesis. After the surgery the patient's neurological examination improved and follow up radiological studies confirmed the successful decompression of the epidural space. Tailoring not only the level but also the laterality of the tandem tubular approach, may be beneficial in minimizing soft tissues trauma, blood loss, operative time and need for more extensive surgical exposure, while successfully treating rare holospinal epidural infections. Minimally invasive tailored decompression of holocord spinal epidural abscesses should be considered as a surgical option in selected patients presenting with acute neurological symptoms.
累及脊柱全长(从颈椎至骶椎区域)的脊髓脓肿较为罕见,约占脊柱硬膜外感染的1%。对于这些患者,通常建议紧急手术减压并联合抗生素治疗,且根据积液的范围和位置选择最合适的手术入路。我们报告了一例罕见的全脊髓硬膜外脓肿病例,采用颈胸腰串联管状减压椎板切除术并交替切口进行治疗,手术入路根据术前脓肿在矢状面和轴位的范围进行调整。这种微创手术成功地为一名出现急性进行性四肢轻瘫的成年患者引流了硬膜外间隙并进行了减压。术后患者的神经学检查有所改善,后续影像学研究证实硬膜外间隙减压成功。不仅根据串联管状入路的节段,还根据其侧方进行调整,可能有助于将软组织创伤、失血、手术时间和更广泛手术暴露的需求降至最低,同时成功治疗罕见的全脊髓硬膜外感染。对于出现急性神经症状的特定患者,应考虑将全脊髓硬膜外脓肿的微创定制减压作为一种手术选择。
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