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首页> 外文期刊>Neurosurgical focus >Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques
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Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques

机译：脊柱全脊柱硬膜外脓肿：两例说明性病例，并回顾了治疗策略和手术技术

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Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.
机译：尽管脊柱感染的患病率上升，但全脊柱硬膜外脓肿（HEA）的子类别非常少见，需要进行独特的管理。脊柱成像（最好是MRI），现代积极的抗生素治疗以及及时的手术干预仍然是包括HEA在内的所有脊柱感染的护理标准。然而，对于HEA而言，关于手术时机和程度的外科手术决策仍然不明确。描述了包括跳过椎板切开术或椎板成形术的减压，具有不同的临床结果。在这篇综述中，作者介绍了2例HEA患者的示例性病例，这些患者均使用了跳过腹腔镜切除术和硬膜外导管冲洗技术进行了治疗。讨论重点介绍了不同的治疗策略，包括在这些病变中采取保守（非手术）治疗的作用，尤其是在已经确定病原体且对MRI没有质量影响或严重的神经功能缺损的情况下。在过去25年中发表的少于25例HEA病例报告中，决定手术作用的最重要方面是神经系统检查。如果神经系统完好无损，仅药物治疗就能成功治疗近20％。没有报道的病例与颅脑感染相关，因为大孔周围的硬脑膜粘连阻止了鼻腔感染的扩散。传统上，采用冲洗后硬膜外腔入路，除非广泛的局灶腹侧收集引起脐带受压。对于所有严重恶化的患者，手术治疗应作为HEA的辅助治疗策略，而抽吸其他感染部位（如脓肿）可确定感染性病原体，适当的抗生素治疗可避免对神经功能完整的患者进行手术干预。

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