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首页> 外文期刊>Neurosurgical focus >Timing in the surgical evacuation of spinal epidural abscesses
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Timing in the surgical evacuation of spinal epidural abscesses

机译：脊柱硬膜外脓肿手术疏散的时机

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Object: One often overlooked aspect of spinal epidural abscesses (SEAs) is the timing of surgical management. Limited evidence is available correlating earlier intervention with outcomes. Spinal epidural abscesses, once a rare diagnosis carrying a poor prognosis, are steadily becoming more common, with one recent inpatient meta-analysis citing an approximate incidence of 1 in 10,000 admissions with a mortality approaching 16%. One key issue of contention is the benefit of rapid surgical management of SEA to maximize outcomes. Timing of surgical management is definitely one overlooked aspect of care in spinal infections. Therefore, the authors performed a retrospective analysis in which they evaluated patients who underwent early (evacuation within 24 hours) versus delayed surgical intervention (> 24 hours) from the point of diagnosis, in an attempt to test the hypothesis that earlier surgery results in improved outcomes. Methods: A retrospective review of a prospectively maintained adult neurosurgical database from 2009 to 2011 was conducted for patients with the diagnostic heading: epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. The primary end point for each patient was neurological grade, measured as an American Spinal Injury Association Impairment Scale grade using hospital inpatient records on admission and discharge. Patients were divided into early surgical (< 24 hours) and delayed surgical cohorts. Results: Eighty-seven consecutive patients were identified (25 females; mean age 55.5 years, age range 18-87 years). Fifty-four patients received surgery within 24 hours of admission (mean time from admission to incision, 11.2 hours), and 33 underwent surgery longer than 24 hours (mean 59 hours) after admission. Of the 54 patients undergoing early surgery 45 (85%) had a neurological deficit, whereas in the delayed surgical group 21 (64%) of 33 patients presented with a neurological deficit (p = 0.09). Patients in the delayed surgery cohort were significantly older by 10 years (59.6 vs 51.8 years, p = 0.01). With regard to history of prior revision, body mass index, intravenous drug abuse, tobacco use, prior radiation therapy, diabetes, chronic systemic infection, and prior osteomyelitis, there were no significant differences. There was no significant difference between early and delayed surgery groups in neurological grade on presentation, discharge, or location of epidural abscess. The most common organism isolated was Staphylococcus aureus (n = 51, 59.3%). The incidence of methicillin-resistant S. aureus was 21% (18 of 87). Conclusions: Evacuation within 24 hours appeared to have a relative advantage over delayed surgery with regard to discharge neurological grade. However, due to a limited, variable sample size, a significant benefit could not be shown. Further subgroup analyses with larger populations are required.
机译：目的：脊柱硬膜外脓肿（SEA）经常被忽视的一个方面是手术管理的时机。有限的证据可以将早期干预与预后相关联。脊柱硬膜外脓肿曾经是一种罕见的诊断，预后差，现在正逐渐变得越来越普遍，最近的一项住院荟萃分析指出，每10,000例入院患者中约有1例发病，死亡率接近16％。争论的一个关键问题是对SEA进行快速外科治疗以使结果最大化的好处。脊柱感染的手术治疗时机无疑是一个被忽视的方面。因此，作者进行了一项回顾性分析，在该分析中，他们从诊断的角度评估了较早接受手术（在24小时内撤离）与延迟接受手术干预（> 24小时）的患者，以尝试验证早期手术可改善病情的假设结果。方法：回顾性分析2009年至2011年间前瞻性维护的成人神经外科数据库，其诊断标题为：硬膜外脓肿，感染，骨髓炎，骨盘炎，脊椎盘炎和脓肿。每位患者的主要终点是神经系统等级，使用美国住院病人住院记录和出院记录，以美国脊髓损伤协会减损量表等级进行测量。将患者分为早期手术组（<24小时）和延迟手术组。结果：确定了八十七名连续患者（25名女性;平均年龄55.5岁，年龄范围18-87岁）。 54名患者在入院24小时内（从入院到切开的平均时间为11.2小时）接受了手术，其中33例入院时间超过了24小时（平均59小时）。在接受早期手术的54位患者中，有45位（85％）有神经功能缺损，而在延迟手术组中，有33位患者中有21位（64％）出现神经功能缺损（p = 0.09）。延迟手术队列中的患者的年龄显着增加了10岁（59.6 vs 51.8岁，p = 0.01）。关于先前的修订史，体重指数，静脉内药物滥用，吸烟，先前的放射疗法，糖尿病，慢性全身感染和先前的骨髓炎，没有显着差异。早期和延迟手术组在硬膜外脓肿的表现，出院或位置方面在神经学等级上无显着差异。分离的最常见的生物是金黄色葡萄球菌（n = 51，59.3％）。耐甲氧西林的金黄色葡萄球菌的发生率为21％（87中的18）。结论：就出院神经功能而言，在24小时内撤离似乎比延迟手术具有相对优势。但是，由于有限的可变样本量，因此无法显示出明显的优势。需要对更大的人群进行进一步的亚组分析。

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