Kim Min Seok, Desai Atman, Yu Dongwoo, Sanker Vivek, Kim Sang Woo, Jeon Ikchan
Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Department of Neurosurgery, Stanford University Hospital, Stanford University School of Medicine, Palo Alto, CA, USA.
Korean J Neurotrauma. 2024 Dec 27;20(4):276-288. doi: 10.13004/kjnt.2024.20.e48. eCollection 2024 Dec.
The aim of this study was to investigate the efficacy of additional surgical decompression with antibiotics to treat pyogenic spinal epidural abscess (SEA) with no neurological deficits.
We retrospectively reviewed the data of patients diagnosed with spontaneous pyogenic SEA in the thoracolumbosacral area who presented with sciatica and no motor deficits in the lower extremities. The treatment took place in a single tertiary hospital. The effects of additional surgical decompression (decompressive laminectomy) and other clinical variables on functional outcome were assessed using the short form 36 (SF-36).
Fifty-nine patients (49 men and 10 women, mean age 65.73±12.29 [41-89] years) were included in the analysis. Surgical decompression had been performed in 31 patients (Group S, treated with additional surgical decompression and antibiotics). There were five (15.2%, 5/33) unplanned operations to control leg sciatica among the patients with initially non-surgical plans, and 28 patients were finally treated with only antibiotics (group N-S). Group S showed a statistically significant increased cost of hospitalization compared to group N-S (15,856.37±7,952.83 vs. 10,672.62±4,654.17 US dollars, =0.004) with no superiority of 6-month functional outcome after the completion of antibiotic treatment (53.65±4.74 vs. 51.75±7.96 SF-36 scores, =0.266).
Although there is a possibility of requiring an unplanned operation to control leg sciatica during conservative antibiotic treatment, overall, additional surgical decompression in pyogenic SEA presenting with no motor deficit of the lower extremity showed increased medical burden and no greater benefit in terms of functional outcomes.
本研究旨在探讨附加手术减压联合抗生素治疗无神经功能缺损的化脓性脊柱硬膜外脓肿（SEA）的疗效。
我们回顾性分析了在一所三级医院就诊的胸腰段及腰骶部自发性化脓性SEA患者的数据，这些患者表现为坐骨神经痛且下肢无运动功能缺损。采用简短健康调查问卷36项量表（SF-36）评估附加手术减压（减压性椎板切除术）及其他临床变量对功能结局的影响。
纳入分析的患者共59例（男49例，女10例，平均年龄65.73±12.29[41-89]岁）。31例患者接受了手术减压（S组，接受附加手术减压及抗生素治疗）。最初计划非手术治疗的患者中有5例（15.2%，5/33）因控制腿部坐骨神经痛而接受了非计划手术，28例患者最终仅接受抗生素治疗（非手术组）。与非手术组相比，S组住院费用显著增加（15856.37±7952.83美元对10672.62±4654.17美元，P=0.004），抗生素治疗结束后6个月的功能结局并无优势（SF-36评分分别为53.65±4.74和51.75±7.96，P=0.266）。
尽管在保守抗生素治疗期间可能需要进行非计划手术以控制腿部坐骨神经痛，但总体而言，对于无下肢运动功能缺损的化脓性SEA患者，附加手术减压增加了医疗负担，且在功能结局方面并无更大益处。
