Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Karatsu,, Japan.
Nagoya J Med Sci. 2021 Feb;83(1):1-20. doi: 10.18999/nagjms.83.1.1.
We aimed to determine available evidences in the literature regarding surgical approaches and methods, timing of surgical interventions, duration of perioperative antibiotics, and duration of nonsurgical treatments (antibiotics administration) in patients with upper cervical (occiput-C2) epidural abscess (UCEA). We performed a literature review of the articles on surgical interventions and antibiotic therapy to treat UCEA, searching the PubMed database for relevant articles published in the English language (as of March 2020). In total, 53 patients with UCEA were identified. Permanent limb paralysis or death was observed in 1/15 (6.7%) patients who received the transoral approach and 2/15 (13.3%) patients who received the transcervical approach, 1/26 (3.8%) patients who underwent surgery before the onset of paralysis, and 2/4 (50.0%) patients who underwent surgery after the onset of paralysis. In 85%-89% of cases, antibiotic administration was continued for 6-12 weeks, which was determined by the confirmation of reduced inflammatory response and/or abscess disappearance on imaging. Differences in surgical approaches may not be associated with the incidence of permanent limb paralysis or death. Surgical interventions before limb paralysis onset are recommended in UCEA patients. In perioperative and nonoperative treatments, antibiotic administration for 6-12 weeks may be supported based on the confirmation of reduced inflammatory response and/or abscess disappearance on imaging. Further investigations are needed.
我们旨在确定文献中有关上颈椎（枕骨-C2）硬膜外脓肿（UCEA）患者手术入路和方法、手术干预时机、围手术期抗生素使用时间以及非手术治疗（抗生素给药）时间的可用证据。我们对治疗 UCEA 的手术干预和抗生素治疗的文献进行了综述，在 PubMed 数据库中搜索了截至 2020 年 3 月以英文发表的相关文章。总共确定了 53 例 UCEA 患者。经口入路治疗的 15 例（6.7%）和经颈椎入路治疗的 15 例（13.3%）患者出现永久性肢体瘫痪或死亡，发病前接受手术的 26 例（3.8%）患者中，有 1 例发生瘫痪，发病后接受手术的 4 例（50.0%）患者中有 2 例发生瘫痪。85%-89%的病例中，抗生素的使用时间为 6-12 周，这是通过影像学检查确认炎症反应减轻和/或脓肿消失来确定的。手术入路的差异可能与永久性肢体瘫痪或死亡的发生率无关。建议在 UCEA 患者中在肢体瘫痪发生前进行手术干预。在围手术期和非手术治疗中，可根据影像学检查确认炎症反应减轻和/或脓肿消失来支持使用抗生素 6-12 周。需要进一步的研究。
