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定制式微创管状椎板切除术用于罕见全脊髓硬脊膜外脓肿的紧急治疗:病例报告及技术回顾

Tailored minimally invasive tubular laminectomies for the urgent treatment of rare holocord spinal epidural abscess: case report and review of technique.

作者信息

Roberti Fabio

机构信息

Section of Neurosurgery, Cleveland Clinic Indian River Hospital, Vero Beach, FL, USA.

Department of Neurological Surgery, The George Washington University, Washington DC, USA.

出版信息

J Spine Surg. 2020 Dec;6(4):729-735. doi: 10.21037/jss-20-603.


DOI:10.21037/jss-20-603
PMID:33447675
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7797810/
Abstract

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.

摘要

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。

相似文献

[1]
Tailored minimally invasive tubular laminectomies for the urgent treatment of rare holocord spinal epidural abscess: case report and review of technique.

J Spine Surg. 2020-12

[2]
Holospinal epidural abscesses - Institutional experience.

J Clin Neurosci. 2018-2

[3]
Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature.

Acta Neurochir Suppl. 2019

[4]
Extensive spinal epidural abscess treated with "apical laminectomies" and irrigation of the epidural space: report of 2 cases.

J Neurosurg Spine. 2015-3

[5]
Pediatric Holocord Epidural Abscess Treated with Apical Laminotomies with Catheter-directed Irrigation and Drainage.

Cureus. 2019-9-23

[6]
Treatment of holocord spinal epidural abscess via alternating side unilateral approach for bilateral laminectomy.

W V Med J. 2015

[7]
Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique.

Spine (Phila Pa 1976). 2004-7-15

[8]
Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.

Neurosurg Focus. 2014-8

[9]
Minimally invasive tubular laminectomies in multilevel spine surgery-an illustrative case-based review of techniques and combined approaches.

J Spine Surg. 2021-3

[10]
Holocord spinal epidural abscess.

J Child Neurol. 2009-6

引用本文的文献

[1]
Extensive spinal epidural abscess treated utilizing a single limited incision: illustrative case.

J Neurosurg Case Lessons. 2025-4-7

[2]
Extensive spinal epidural abscess caused by Staphylococcus epidermidis: A case report and literature review.

Front Surg. 2023-3-8

[3]
Holospinal epidural abscess caused by : a literature review.

BMJ Case Rep. 2022-12-1

本文引用的文献

[1]
Ventral holocord spinal epidural abscess managed surgically in a critical setting.

Surg Neurol Int. 2019-12-13

[2]
Minimally Invasive Laminotomy for Contralateral "Over-the-Top" Foraminal Decompression Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown). 2020-9-1

[3]
Pediatric Holocord Epidural Abscess Treated with Apical Laminotomies with Catheter-directed Irrigation and Drainage.

Cureus. 2019-9-23

[4]
A rare case of holocord spinal epidural abscess.

QJM. 2020-4-1

[5]
Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy: a rare case report with literature review.

Spinal Cord Ser Cases. 2019-7-2

[6]
"One and a half" minimally invasive transforaminal lumbar interbody fusion: single level transforaminal lumbar interbody fusion with adjacent segment unilateral laminotomy for bilateral decompression for spondylolisthesis with bisegmental stenosis.

J Spine Surg. 2018-12

[7]
Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature.

Acta Neurochir Suppl. 2019

[8]
Skip Hemilaminectomy for Large, Multilevel Spinal Epidural Hematomas: Report of a Series of 11 Patients.

World Neurosurg. 2018-3

[9]
Holospinal epidural abscesses - Institutional experience.

J Clin Neurosci. 2018-2

[10]
The Use of a "Double-Triple Barrel" Technique during Minimally Invasive Multilevel Tubular Laminectomy. A Technical Note.

J Neurol Surg A Cent Eur Neurosurg. 2017-3

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