Almotairi Fawaz S, Alsaleh Alwaleed Abdulrahman, Basalamah Ali A, Mallat Mohannad M, Babateen Emad M, Abdu Ali, Bahabri Saeed O
Department of Neurosurgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Medical Intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Surg Neurol Int. 2023 Sep 8;14:315. doi: 10.25259/SNI_536_2023. eCollection 2023.
Spinal infections are associated with a wide variety of clinical conditions, including osteomyelitis, spondylitis, diskitis, septic facet joints, and abscesses. Based on its anatomical relationship with the dura mater, the abscess can be epidural (extradural) or subdural (intrathecal). Subdural intramedullary abscesses of the lumbar spinal canal are more common than subdural extramedullary abscesses. Here, we present a rare case of a patient with a mixed pyogenic and tuberculous epidural abscess in the lumbar spine, which perforated the dura and extended to the subdural space.
A 29-year-old male presented with progressively worsening back pain and lower-limb weakness over a period of 3 months, with an associated inability to walk, intermittent radicular pain primarily on the left side, intermittent incontinence, and a history of low-grade fever and night sweats. The patient had a history of intravenous (IV) drug abuse and reported practicing unprotected sexual intercourse. Furthermore, the patient had recently came into contact with a person diagnosed with tuberculosis (TB). The patient was administered empirical broad-spectrum antibiotics and underwent emergent L4-L5 laminectomy and spinal abscess decompression. IV antibiotics were selected based on culture results, and anti-TB medications were started. Postoperatively, the patient demonstrated a remarkable lower-limb power improvement and radicular pain alleviation.
Spinal epidural abscess perforation of the dura and extension into the subdural space is extremely rare. Distinguishing between epidural and subdural abscesses radiologically is challenging. Multiple risk factors, such as unprotected sexual contact and IV drug misuse, may be associated with the development of polymicrobial abscesses in the lumbar spine. Careful anticipation, identification, and isolation of the causative micro-organisms can ensure effective antibacterial treatment. Early diagnosis, expeditious surgical decompression, and antibiotic treatment are associated with promising outcomes.
脊柱感染与多种临床病症相关，包括骨髓炎、脊柱炎、椎间盘炎、化脓性小关节病和脓肿。根据其与硬脑膜的解剖关系，脓肿可分为硬膜外（硬脊膜外）或硬膜下（鞘内）。腰椎管内硬膜下髓内脓肿比硬膜下髓外脓肿更常见。在此，我们报告一例罕见病例，一名患者腰椎出现化脓性和结核性混合性硬膜外脓肿，脓肿穿破硬脑膜并延伸至硬膜下间隙。
一名29岁男性，在3个月内出现逐渐加重的背痛和下肢无力，伴有无法行走、主要为左侧的间歇性神经根性疼痛、间歇性尿失禁，以及低热和盗汗病史。该患者有静脉注射毒品史，并报告有不安全性行为。此外，该患者最近与一名被诊断为结核病（TB）的人有过接触。给予经验性广谱抗生素治疗，并紧急进行L4-L5椎板切除术和脊柱脓肿减压术。根据培养结果选择静脉用抗生素，并开始使用抗结核药物。术后，患者下肢力量明显改善，神经根性疼痛减轻。
脊柱硬膜外脓肿穿破硬脑膜并延伸至硬膜下间隙极为罕见。通过影像学区分硬膜外脓肿和硬膜下脓肿具有挑战性。多种危险因素，如不安全性接触和静脉药物滥用，可能与腰椎多微生物脓肿的发生有关。仔细预测、识别和分离致病微生物可确保有效的抗菌治疗。早期诊断、迅速的手术减压和抗生素治疗可带来良好的预后。
