经皮后路椎弓根螺钉固定术后，椎管硬膜外脓肿大小意外迅速缩小，无需减压手术：一例报告。
Unexpectedly rapid decrease in the size of a spinal epidural abscess after percutaneous posterior pedicle screw fixation without decompression surgery: a case report.
机构信息
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.
Department of Orthopaedic Surgery, Kubota Orthopaedic Clinic, Katori, Chiba, Japan.
出版信息
Spinal Cord Ser Cases. 2022 Aug 13;8(1):77. doi: 10.1038/s41394-022-00543-5.
INTRODUCTION
Spondylodiscitis accompanying spinal epidural abscess is often treated with decompression surgery when there are neurological symptoms. We report a case of spondylodiscitis accompanying spinal epidural abscess with severe lower extremity pain that was successfully treated with percutaneous posterior pedicle screw fixation without decompression surgery.
CASE PRESENTATION
A 53-year-old man was admitted to our hospital with severe low back pain (LBP), lower extremity pain and numbness, and fever. Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis at L2-L3 and a small epidural abscess located ventrally in the spinal canal. Initially, the patient was treated conservatively with empirical antibiotics. However, the lower extremity symptoms worsened and the epidural abscess expanded cranially to the T12 level. Percutaneous pedicle screw fixation without decompression was performed thirty-three days after admission. Postoperatively, the LBP and lower extremity pain dramatically improved. A postoperative MRI performed one week post-operatively showed an unexpectedly rapid decrease in the size of the epidural abscess, although no decompression surgery was performed. Two months after surgery, the epidural abscess completely disappeared. At the final follow-up (five years postoperatively), no recurrence of epidural abscess was observed, and the patient had no symptoms or disturbance of activities of daily living.
DISCUSSION
This surgical strategy should be carefully selected for patients with spondylodiscitis with accompanying spinal epidural abscess who have lower extremity symptoms. The stabilising effect of pedicle screw fixation may be advantageous for controlling spinal infections. Percutaneous posterior pedicle screw fixation without decompression is an optional treatment for spondylodiscitis accompanying spinal epidural abscess.
介绍
当存在神经症状时，伴有脊髓硬膜外脓肿的脊椎炎通常采用减压手术治疗。我们报告一例伴有严重下肢疼痛的脊髓硬膜外脓肿的脊椎炎，通过后路经皮椎弓根螺钉固定术成功治疗，无需减压手术。
病例介绍
一名 53 岁男性因严重腰痛（LBP）、下肢疼痛和麻木以及发热而入院。腰椎磁共振成像（MRI）显示 L2-L3 脊椎炎和位于椎管腹侧的小硬膜外脓肿。最初，患者接受经验性抗生素保守治疗。然而，下肢症状恶化，硬膜外脓肿向颅侧扩展至 T12 水平。入院后 33 天进行了无需减压的经皮椎弓根螺钉固定术。术后，LBP 和下肢疼痛显著改善。术后一周进行的 MRI 显示硬膜外脓肿出乎意料地迅速缩小，尽管未进行减压手术。术后两个月，硬膜外脓肿完全消失。在最后一次随访（术后五年）时，未观察到硬膜外脓肿复发，患者无任何症状或日常生活活动障碍。
讨论
对于伴有下肢症状的脊髓硬膜外脓肿的脊椎炎患者，应仔细选择这种手术策略。椎弓根螺钉固定的稳定作用可能有利于控制脊柱感染。后路经皮椎弓根螺钉固定术无需减压是治疗伴有脊髓硬膜外脓肿的脊椎炎的一种可选治疗方法。
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