Aoki Yasuchika, Sato Masashi, Iida Akihiro, Sato Yusuke, Ohtori Seiji
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, 283-8686, Chiba, Japan.
Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Eur Spine J. 2025 Feb;34(2):650-656. doi: 10.1007/s00586-024-08627-6. Epub 2025 Jan 13.
Spinal epidural abscesses are rare yet serious conditions, often necessitating emergency surgical intervention. Holospinal epidural abscesses (HEA) extending from the cervical to the lumbosacral spine are even rarer and present significant challenges in management. This report aims to describe a case of HEA with both ventrally-located cervical and dorsally-located thoracolumbar epidural abscesses treated with a combination of anterior keyhole decompression and posterior skip decompression surgeries.
A 73-year-old woman with diabetes and hypertension presented with severe neck and back pain, fever, and a marked increase in leukocytes (29980/µL) and C-reactive protein (CRP; 24.26 mg/dL) levels. Magnetic resonance imaging revealed epidural abscesses extending from the cervical to lumbar spine, confirming the diagnosis of HEA. At the cervical lesion, spinal cord was compressed by ventrally-located epidural abscess. Due to the patient's poor general condition, conservative treatment was initially pursued, followed by surgical intervention targeting the most severely compressed spinal segments. Managing ventrally-located epidural abscesses poses greater challenges. In this patient, a novel anterior keyhole decompression surgery was employed to evacuate the ventrally-located cervical epidural abscess while preserving intervertebral discs and endplates.
Posterior skip decompression surgery was performed, successfully reducing thoracolumbar epidural abscesses. Subsequently, anterior keyhole decompression was performed to evacuate ventrally-located epidural abscess, preserving intervertebral discs and endplates. Postoperatively, the patient's symptoms improved, and leukocyte count and CRP gradually normalized. Follow-up imaging showed resolution of the abscesses and bone remodeling within the keyhole without evidence of spinal instability and postoperative kyphosis.
Management of HEA poses significant challenges, particularly in cases with ventrally-located cervical epidural abscesses. Our case highlights the efficacy of a combined surgical approach involving anterior keyhole decompression and posterior skip decompression in achieving abscess drainage and preserving spinal stability. This novel technique offers advantages over existing methods by preserving intervertebral motion and minimizing the risk of postoperative kyphosis. Further studies are warranted to validate the long-term outcomes and generalizability of this approach.
脊柱硬膜外脓肿虽罕见但病情严重，常需紧急手术干预。从颈椎延伸至腰骶椎的全脊柱硬膜外脓肿（HEA）更为罕见，在治疗上存在重大挑战。本报告旨在描述一例HEA病例，该病例同时存在位于颈椎腹侧和胸腰椎背侧的硬膜外脓肿，采用前路锁孔减压和后路跳跃减压手术联合治疗。
一名患有糖尿病和高血压的73岁女性，出现严重的颈部和背部疼痛、发热，白细胞计数（29980/µL）和C反应蛋白（CRP；24.26mg/dL）水平显著升高。磁共振成像显示硬膜外脓肿从颈椎延伸至腰椎，确诊为HEA。在颈椎病变处，腹侧硬膜外脓肿压迫脊髓。由于患者全身状况较差，最初采取保守治疗，随后针对受压最严重的脊髓节段进行手术干预。处理腹侧硬膜外脓肿面临更大挑战。在该患者中，采用了一种新颖的前路锁孔减压手术来清除颈椎腹侧硬膜外脓肿，同时保留椎间盘和终板。
进行了后路跳跃减压手术，成功减轻了胸腰椎硬膜外脓肿。随后，进行前路锁孔减压以清除腹侧硬膜外脓肿，保留椎间盘和终板。术后，患者症状改善，白细胞计数和CRP逐渐恢复正常。随访影像学检查显示脓肿消退，锁孔内骨质重塑，无脊柱不稳定和术后后凸畸形的迹象。
HEA的治疗存在重大挑战，尤其是对于伴有颈椎腹侧硬膜外脓肿的病例。我们的病例突出了前路锁孔减压和后路跳跃减压联合手术方法在实现脓肿引流和保持脊柱稳定性方面的有效性。这种新技术通过保留椎间活动并将术后后凸畸形风险降至最低，比现有方法具有优势。有必要进行进一步研究以验证该方法的长期疗效和通用性。
