Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan.
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.
Spinal Cord Ser Cases. 2021 May 13;7(1):38. doi: 10.1038/s41394-021-00401-w.
Holospinal epidural abscess (HEA) extending from the cervical to the lumbosacral spine is an extremely rare condition. Surgical treatment of HEA, which involves extensive decompression of the spinal lesion is difficult in emergency settings. However, the authors successfully treated a case of HEA in critical condition with severe neurological deficits through a combination of skip decompression surgeries and catheter irrigation.
A 73-year-old man complained of neck and back pain and developed muscle weakness in the upper and lower extremities (C5 AIS D tetraplegia). When he was transferred to our hospital, a marked increase in leukocytes (13330/μL) and C-reactive protein levels (32.11 mg/dL) was observed. Magnetic resonance imaging (MRI) revealed a HEA extending from C1 to S2 levels. Therefore, an emergency posterior decompression on C4-5 and T4-7 was performed, followed by catheter irrigation using a venous catheter. Blood and intraoperative isolated microorganisms were identified as Streptococcus intermedius, which is a rare cause of spinal infection. He experienced marked improvement in pain after surgery. Two months after surgery, the epidural abscess completely disappeared. Motor weakness gradually improved, and he was able to walk without support and showed no pain recurrence during the final follow-up (20 months after surgery).
Early diagnosis is important for the treatment of HEAs. Therefore, a whole spine MRI is recommended when an extensive spinal epidural abscess is suspected. Decompression surgery at limited spine levels followed by catheter irrigation should be considered in patients with HEA.
从颈椎延伸至胸腰骶椎的全脊柱硬脊膜外脓肿（HEA）极为罕见。HEA 需广泛减压以治疗脊柱病变，在紧急情况下手术难度较大。然而，作者通过多次跳跃式减压手术和导管灌洗成功治疗了一例合并严重神经功能缺损的危重 HEA 病例。
一名 73 岁男性主诉颈背痛，并出现上下肢肌无力（C5 AIS D 四肢瘫痪）。当他转入我院时，白细胞（13330/μL）和 C 反应蛋白水平（32.11mg/dL）显著升高。磁共振成像（MRI）显示 HEA 从 C1 延伸至 S2 水平。因此，我们立即进行了 C4-5 和 T4-7 的紧急后路减压，并使用静脉导管进行了导管灌洗。血液和术中分离的微生物被鉴定为中间链球菌，这是一种罕见的脊髓感染病原体。术后，患者疼痛明显缓解。术后 2 个月，硬脊膜外脓肿完全消失。运动无力逐渐改善，最终随访时（术后 20 个月）患者已无需支撑即可行走，且无疼痛复发。
早期诊断对于 HEA 的治疗至关重要。因此，当怀疑广泛的脊柱硬脊膜外脓肿时，推荐进行全脊柱 MRI 检查。对于 HEA 患者，应考虑在有限的脊柱节段进行减压手术，随后进行导管灌洗。
