Jabbar Redwan, Szmyd Bartosz, Jankowski Jakub, Lusa Weronika, Pawełczyk Agnieszka, Wysiadecki Grzegorz, Tubbs R Shane, Iwanaga Joe, Radek Maciej
Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland.
Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland.
J Clin Med. 2022 Aug 31;11(17):5148. doi: 10.3390/jcm11175148.
Intramedullary spinal cord abscess (ISCA) is a rare clinical pathology of the central nervous system that usually accompanies other underlying comorbidities. Traditionally it has been associated with significant mortality and neurological morbidities because it is often difficult to diagnose promptly, owing to its nonspecific clinical and neuroimaging features. The mortality rate and the outcome of these infections have been improved by the introduction into clinical practice of antibiotics, advanced neuroimaging modalities, and immediate surgery. We report the case of a 65-year-old male patient who presented with a progressive spastic gait and lumbar pain, predominantly in the left leg. An MRI image revealed an expansile intramedullary cystic mass in the thoracic spinal cord, which was initially diagnosed as a spinal tumor. He underwent laminectomy and myelotomy, and eventually the pus was drained from the abscess. The follow-up MRI showed improvement, but the patient's paraplegia persisted. In light of his persistent hypoesthesia and paraplegic gait with developing neuropathic pain, he was readmitted, and an MRI of his lumbar spine revealed multilevel degenerative disease and tethered spinal cord syndrome with compression of the medulla at the L2-L3 level. The patient underwent central flavectomy with bilateral foraminotomy at the L2-L3 level, and the medulla was decompressed. Postoperatively, his neurological symptoms were significantly improved, and he was discharged from hospital on the third day after admission. In support of our case, we systematically reviewed the recent literature and analyzed cases published between 1949 and May 2022, including clinical features, mechanisms of infection, predisposing factors, radiological investigations, microbial etiologies, therapies and their duration, follow-ups, and outcomes. Initial clinical presentation can be misleading, and the diagnosis can be challenging, because this condition is rare and coexists with other spinal diseases. Hence, a high index of suspicion for making an accurate diagnosis and timely intervention is required to preclude mortality and unfavorable outcomes. Our case is a clear example thereof. Long-term follow-up is also essential to monitor for abscess recurrences.
脊髓髓内脓肿（ISCA）是一种罕见的中枢神经系统临床病理情况，通常伴有其他潜在合并症。传统上，它与显著的死亡率和神经功能障碍相关，因为其临床和神经影像学特征不具特异性，往往难以迅速诊断。抗生素、先进的神经影像学检查手段以及立即手术应用于临床实践后，这些感染的死亡率和治疗结果得到了改善。我们报告一例65岁男性患者，其表现为进行性痉挛性步态和腰痛，主要累及左腿。磁共振成像（MRI）显示胸段脊髓有一个膨胀性髓内囊性肿块，最初被诊断为脊髓肿瘤。他接受了椎板切除术和脊髓切开术，最终脓肿得以引流脓液。随访MRI显示有所改善，但患者的截瘫仍然存在。鉴于其持续存在的感觉减退和截瘫步态，并伴有神经病理性疼痛，他再次入院，腰椎MRI显示多节段退行性疾病和脊髓拴系综合征，L2 - L3水平脊髓受压。患者接受了L2 - L3水平的中央黄韧带切除术及双侧椎间孔切开术，脊髓得到减压。术后，他的神经症状明显改善，入院第三天出院。为支持我们的病例，我们系统回顾了近期文献，并分析了1949年至2022年5月期间发表的病例，包括临床特征、感染机制、易感因素、影像学检查、微生物病因、治疗方法及其持续时间、随访情况和结果。初始临床表现可能具有误导性，诊断可能具有挑战性，因为这种情况罕见且与其他脊柱疾病并存。因此，需要高度的怀疑指数以做出准确诊断并及时干预，以避免死亡和不良后果。我们的病例就是一个明显的例子。长期随访对于监测脓肿复发也至关重要。
