Rigamonti D, Liem L, Wolf A L, Fiandaca M S, Numaguchi Y, Hsu F P, Nussbaum E S
Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287.
Mt Sinai J Med. 1994 Sep;61(4):357-62.
A ten-year retrospective review of 23 cases of documented spinal epidural abscess in the cervical spine was undertaken to define the clinical features and establish current diagnostic and therapeutic criteria. Diagnosis was made by magnetic resonance imaging or myelography. Risk factors included intravenous drug abuse, diabetes mellitus, previous trauma, and a positive serologic test for the human immunodeficiency virus. A bacterial agent was isolated in 21 cases (91%). Neurologic deficits were present in 20 of the cases (87%) at the time of diagnosis. Erythrocyte sedimentation rate was elevated in all patients in whom it was measured. All patients were treated with appropriate antibiotics, usually for 6 to 8 weeks. Twenty-one patients underwent operative procedures using percutaneous aspiration (1 patient), the anterior approach (14 patients) or the posterior approach (4 patients), or a combination of the two approaches (2 patients). Four of ten patients who initially had less than antigravity strength were eventually ambulatory and continent; in each case, operative decompression was performed within 36 hours of initial consultation. Three patients who had no initial neurologic deficits remained intact.
对23例有记录的颈椎硬膜外脓肿患者进行了为期十年的回顾性研究，以明确其临床特征并确立当前的诊断和治疗标准。诊断通过磁共振成像或脊髓造影做出。危险因素包括静脉药物滥用、糖尿病、既往创伤以及人类免疫缺陷病毒血清学检测呈阳性。21例（91%）分离出细菌病原体。20例（87%）患者在诊断时存在神经功能缺损。所有接受检测的患者红细胞沉降率均升高。所有患者均接受了适当的抗生素治疗，通常持续6至8周。21例患者接受了手术治疗，采用经皮抽吸术（1例）、前路手术（14例）或后路手术（4例），或两种手术方式联合（2例）。最初肌力低于抗重力水平的10例患者中有4例最终能够行走且大小便自控；在每种情况下，均在初次会诊后36小时内进行了手术减压。3例最初无神经功能缺损的患者仍保持完好。
