Mitani Koki, Minami Manabu, Takahashi Toshiyuki, Toyoda Mariko, Kanematsu Ryo, Hanakita Junya
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan.
Surg Neurol Int. 2024 Mar 15;15:87. doi: 10.25259/SNI_740_2023. eCollection 2024.
Spinal epidural abscess (SEA) is a rare condition that may result in catastrophic outcomes. On the other hand, calcium pyrophosphate (CPP) deposition disease (CPPD) causes inflammatory arthritis. Spinal involvement of a crystal-induced inflammation caused by CPPD is also common. Surgery is a common risk factor for both SEA and CPPD; however, the postoperative acute onset of SEA complicated with CPPD is extremely rare.
A man in his 70s presented to our hospital, complaining of right upper limb weakness, loss of dexterity, and gait disturbance. The diagnosis of cervical spondylotic myelopathy was made, and he performed laminectomy at C3, C4, and C5 levels. Four days after the laminectomy, he suffered from acute neck pain, weakness, and hypoesthesia in his arms and legs. Magnetic resonance imaging revealed a mass occupying the dorsal epidural space of C6 and C7, compressing the cervical spinal cord. Considering the acute symptomatology, an acute spinal epidural hematoma after surgery was suspected; therefore, emergency C6 and C7 laminectomy was performed. Surgical findings indicated that the pressure inside the spinal canal was elevated, and the mass was purulent exudate. Pathological examination showed suppurative inflammation with concomitant deposition of CPP. SEA complicated with CPPD was considered; therefore, antibiotics and non-steroidal anti-inflammatory drugs were administered. The motor weakness and hypoesthesia were improved despite a slight residual deficit in his dexterity.
An acute onset of SEA complicated with CPPD after cervical surgery has rarely been reported. The suppurative inflammation fostered by the crystal-induced inflammation may account for the acute symptomatology.
脊柱硬膜外脓肿（SEA）是一种罕见疾病，可能导致灾难性后果。另一方面，焦磷酸钙（CPP）沉积病（CPPD）会引发炎症性关节炎。CPPD引起的晶体诱导性炎症累及脊柱也较为常见。手术是SEA和CPPD的常见危险因素；然而，术后急性发作的SEA合并CPPD极为罕见。
一名70多岁男性到我院就诊，主诉右上肢无力、灵活性丧失和步态障碍。诊断为脊髓型颈椎病，他接受了C3、C4和C5节段的椎板切除术。椎板切除术后四天，他出现急性颈部疼痛、四肢无力和感觉减退。磁共振成像显示C6和C7背侧硬膜外间隙有一占位，压迫颈脊髓。考虑到急性症状，怀疑术后发生急性脊柱硬膜外血肿；因此，进行了急诊C6和C7椎板切除术。手术所见表明椎管内压力升高，肿块为脓性渗出物。病理检查显示化脓性炎症伴CPP沉积。考虑为SEA合并CPPD；因此，给予抗生素和非甾体类抗炎药治疗。尽管其灵活性仍有轻微残留缺陷，但运动无力和感觉减退有所改善。
颈椎手术后急性发作的SEA合并CPPD鲜有报道。晶体诱导性炎症引发的化脓性炎症可能是急性症状的原因。
