Le Shiyong, Tang JiaJun, Zhang Jie, Fu Jiaming, Zhang Wensheng, He Minye, Dai Mengxuan, Wang Liang
Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.
Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangdong Province, Guangzhou, China.
JB JS Open Access. 2025 Jun 20;10(2). doi: 10.2106/JBJS.OA.24.00249. eCollection 2025 Apr-Jun.
» Abscesses caused by spinal tuberculosis typically occur in the anterior and lateral regions of the vertebral bodies, often extending to the paraspinal muscles as cold abscesses. Although intraspinal abscesses due to spinal tuberculosis are very common, cases with longitudinally extensive abscesses in the ventral epidural space of the spinal cord are not well-documented. The disease is characterized by insidious onset, rapid progression, and a high risk of irreversible neurological damage, highlighting the necessity for early diagnosis and prompt treatment. » This review presents 2 rare cases of long-segment tuberculous spinal epidural abscesses, with both patients achieving significant symptom improvement after precise surgical intervention and standardized antituberculosis therapy. A long-segment tuberculous spinal epidural abscess (SEA) is an extremely rare complication that may cause severe neurological impairment, and magnetic resonance imaging revealed extensive spinal epidural abscesses. Clinical manifestations, such as neck stiffness, can easily be mistaken for tuberculous encephalopathy; therefore, contrast-enhanced MRI is recommended to differentiate a SEA from tuberculous encephalopathy. » Local decompression with catheter drainage can help preserve neurological function, establish a definitive etiological diagnosis, and guide subsequent treatment. Early, adequate, and comprehensive antituberculosis therapy is crucial for successful management.
脊柱结核引起的脓肿通常发生在椎体的前部和外侧区域，常作为寒性脓肿延伸至椎旁肌肉。虽然脊柱结核引起的椎管内脓肿很常见，但脊髓腹侧硬膜外间隙出现纵向广泛脓肿的病例报道较少。该病起病隐匿，进展迅速，有不可逆神经损伤的高风险，凸显了早期诊断和及时治疗的必要性。
本综述介绍了2例罕见的长节段结核性脊柱硬膜外脓肿病例，2例患者在精确的手术干预和标准化抗结核治疗后症状均有明显改善。长节段结核性脊柱硬膜外脓肿（SEA）是一种极其罕见的并发症，可导致严重神经功能损害，磁共振成像显示广泛的脊柱硬膜外脓肿。临床表现如颈部僵硬等，很容易被误诊为结核性脑病；因此，建议采用对比增强磁共振成像来鉴别SEA与结核性脑病。
局部减压并置管引流有助于保留神经功能、明确病因诊断并指导后续治疗。早期、充分和全面的抗结核治疗对于成功治疗至关重要。
