Schlossberg D, Shulman J A
South Med J. 1977 Jun;70(6):669-73. doi: 10.1097/00007611-197706000-00010.
This paper describes problems in the diagnosis and management of six patients with spinal epidural abscess. Since the clinical findings in this disease process are frequently misinterpreted, one must be careful to exclude this diagnosis in any patient with fever, leukocytosis, back pain and recent infection or back trauma. Alcoholic patients, in particular, seem at high risk for missed diagnosis since the clinical findings are frequently misinterpreted to be complications of alcoholism. Suspicion of spinal epidural abscess should lead to immediate lumbar puncture with manometrics as well as myelography. Once the diagnosis is established surgery should be immediate. Gram stains and cultures taken at the time of lumbar puncture or at operation will dictate appropriate antibiotic therapy. The cause of infection can be fairly well determined by the location of the abscess and a knowledge of the pathogenesis. Prognosis seems directly dependent on the preoperative neurologic status of the patient.
本文描述了6例脊柱硬膜外脓肿患者的诊断和治疗问题。由于该疾病过程中的临床表现常被误解，对于任何有发热、白细胞增多、背痛以及近期感染或背部外伤的患者，必须谨慎排除该诊断。尤其是酗酒患者，似乎漏诊风险很高，因为临床表现常被误解为酒精中毒的并发症。怀疑有脊柱硬膜外脓肿时，应立即进行测压腰椎穿刺以及脊髓造影。一旦确诊，应立即进行手术。腰椎穿刺时或手术时进行的革兰氏染色和培养将决定适当的抗生素治疗。感染原因可通过脓肿位置及发病机制知识相当准确地确定。预后似乎直接取决于患者术前的神经状态。
