A Case Report of Thoracic Spondylodiscitis Caused by Staphylococcus aureus with Spinal Epidural Abscess and Paraspinal Abscess: Surgical Management or Medical Treatment Alone?

金黃色葡萄球菌引發之胸椎骨髓炎合併硬脊膜外膿腫與脊髓旁膿腫的病例報告：外科清創或是內科治療即可？

陳昶華(Chang-Hua Chen) ； 陳威良(Wei-Liang Chen) ； 鄭均垣(Chun-Yuan Cheng) ； 張家築(Chia-Chu Chang)

《內科學誌》 26卷5期 (2015/10) Pp. 303-308

摘要

硬脊膜外膿腫，是一種嚴重的脊椎感染，可能導致嚴重神經系統後遺症。外科清創手術治療或單獨抗生素藥物治療仍有爭議。我們報告一例金黃色葡萄球菌脊椎骨髓炎和椎間盤炎並且合併硬脊膜外膿腫與脊髓旁膿腫。一個70歲的男性商人發生胸椎金黃色葡萄球菌脊椎骨髓炎和椎間盤炎合併硬脊膜外膿腫與脊髓旁膿腫。他接受針劑oxacillin兩個月治療。然後轉換成口服dicloxacillin繼續治療，抗生素治療的總時間為8個月。我們建議，如果沒有接受外科清創手術選擇選用保守治療的患者，需要密切觀察臨床症狀，監測erythrocyte sedimentation rate，和需要時候安排核磁共振或斷層掃描。如果神經學症狀有惡化，則可能需要安排緊急手術減壓治療。

並列摘要

Spinal epidural abscess (SEA) is a severe vertebral infection that may lead to catastrophic neurologic sequelae. The choice between surgical management and medical treatment alone for SEA is still controversial. We report a case of SEA managed with medical treatment alone at our institute. The patient was a 70-year-old male merchant who had Staphylococcus aureus spinal osteomyelitis and discitis in T8–T9 extending into the paraspinal and epidural region. He received parenteral oxacillin (2000 mg every 4 h) for 2 months, which was then switched to an oral dicloxacillin (750 mg every 6 h) after the serial follow-up erythrocyte sedimentation rate became normalized. The total duration of antibiotic treatment was 8 months. Accurate diagnosis and adequate treatment of bacterial SEA can improve outcomes. Undoubtedly, the neurological status at the time of presentation is a major factor in treatment decision making and patient outcome. The management decisions involve individual patient considerations. We hope that the decision-making algorithm presented here will be a valuable tool for clinicians.

並列關鍵字

Spinal epidural abscess ； Osteomyelitis ； Discitis ； Paraspinal abscesses ； Staphylococcus aureus ； Decision-making ； Algorithm