School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
J Med Case Rep. 2023 Apr 1;17(1):116. doi: 10.1186/s13256-023-03872-7.
Subdural spinous abscess is a rare pathology that carries significant morbidity if not diagnosed and treated early; of the cases reported in the literature, very few are genuinely spontaneous in nature.
Here we demonstrate the case of an otherwise entirely fit and well 56-year-old White, British female presenting with low back pain, bilateral sciatica and sensate urinary retention; lumbar subdural spinous abscess was diagnosed on urgent magnetic resonance imaging and the patient was successfully managed with surgical evacuation and prolonged antibiotic therapy. The patient made a full neurological recovery and was followed-up in the outpatient setting 12 weeks following her initial surgery; she was pain free with normal inflammatory markers and a normal neurological examination. There have been no further consultations and a telephone call at 20 weeks confirmed that she remains well.
This is the second case reported in the literature of a genuinely spontaneous subdural spinous abscess, which was successfully managed with surgical evacuation following prompt diagnosis. This highlights the need to ensure infective pathologies are kept at the back of one's mind even in the most unlikely circumstances, and that excellent outcomes can be achieved with early surgical intervention.
硬脊膜下棘突脓肿是一种罕见的疾病，如果不能及早诊断和治疗，会带来严重的发病率；在文献中报道的病例中，真正自发的病例非常少。
在这里，我们展示了一位 56 岁的白人、英国女性的病例，她身体状况良好，没有任何其他疾病，仅出现腰痛、双侧坐骨神经痛和感觉性尿潴留；紧急磁共振成像诊断为腰椎硬脊膜下棘突脓肿，患者通过手术清除和长期抗生素治疗成功得到了治疗。患者完全恢复了神经功能，在初次手术后 12 周进行了门诊随访；她无疼痛，炎症标志物正常，神经检查正常。此后再无就诊，20 周的电话随访确认她仍状况良好。
这是文献中报告的第二例真正自发的硬脊膜下棘突脓肿病例，在迅速诊断后通过手术清除成功得到了治疗。这强调了即使在最不可能的情况下，也要始终牢记感染性疾病的可能性，并且早期手术干预可以获得良好的结果。
