Spinal Epidural Abscess: A District Hospital Basis Study

Objective: Spinal epidural abscess (SEA) is a neurological emergency owing to acuminated infectious materials inside the spinal cannel, which leads to severe neurologic deficits. Treatment is imperative to avoid neurologic disability. This study aimed at finding the predictive factors in the early diagnosis and treatment of patient suffered from SEA. Methods: Five cases, diagnosed as SEA, were enrolled in this study. Among them, there were 2 female and 3 Male; mean age=60.60±10.08 (y/o); spinal dispersal =cervical/thoracic/lumbar=1/1/3. Three cases were paraplegia, one quadriplegia. Three cases were febrile. They are victims of hepatic cellular carcinoma(1/5), esophageal squamous cell carcinoma(1/5), and systemic lupus erythematous(1/5). Laboratory data revealed leukocytosis in three and all have elevated C reactive protein(CRP). Results: All the patients received surgical intervention including multilevel laminectomy, debridement and a catheter drainage. Aspirated cultures shew Staphylococcus Aureus(2/5), vancomycin resistant E coli(1/5), Klebsiella pneumonia(1/5) and no growth(1/5) They were discharged after a mean hospitalization 35.2±8.16 days by serum CRP level returned to normal. Further oral antibiotics was administered for two weeks till no elevated CRP. Conclusion: The therapeutic paradigms include empiric antibiotics, rehabilitation and nutrition consultant. This study lends credence to reinforce early diagnosis, surgical intervention and chemical bactericidal remedy leads a better result in SEA patients. Among the laboratory factors, serum CRP becomes a promising factor to indicate the severity of SEA.

關鍵字

C reactive protein ； spinal epidural abscess ； Staphylococcus aureus ； systemic lupus erythematous

並列摘要

目的：脊椎硬膜外膿瘍為發炎物質堆積在脊椎腔內，是一種需緊急治療的神經急症。因為脊椎硬膜外膿瘍患者在發作前徵狀並不明顯，我們希望找出可監測的因子，在治療階段和出院後，預測脊椎硬膜外膿瘍的治療效果。方法：五位患者，年齡從四十一歲至七十二歲不等，男女比率3：2，受影響脊椎分別為頸椎1、胸椎1、腰椎3。高燒僅發生在3位病患，身體檢查發現四肢無力癱瘓1、雙下肢無力或癱瘓3、單一下肢無力者1。血液檢查顯示高白血球數有3人、5人皆有高C反映蛋白。過去病史包含肝癌、食道癌、舌癌、紅斑性狼瘡、類風溼性關節炎。結果：所有患者皆接受椎核磁共振檢查及患部的脊椎手術和清創、引流手術。術後給予抗生素治療。術中取得的分泌物培養：金色葡萄球菌者2、抗萬古黴素腸道菌者1、完全沒有長菌者1。每周檢驗發炎指數。治療期間從28至43天不等。出院後續服口服抗生素，並監測血中C反映蛋白。結論：關於脊椎硬膜外膿瘍報導中，無標準化的治療和預防方法，一旦產生神經缺損，預後往往不佳。因此，對於脊椎硬膜外膿瘍的疾患，C反映蛋白不失為一好的指標，加上手術及抗生素治療，才能改善患者預後。

並列關鍵字

C反映蛋白；脊椎硬膜外膿瘍；金色葡萄球菌；紅斑性狼瘡

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