- 期刊
- OpenAccess
Less invasive surgical evacuation of panspinal epidural abscess by limited laminectomy and suction-irrigation - A report of four cases
摘要
Spinal epidural abscess of multiple level occur very rarely. Surgical evacuation is indicated when infections are not well controlled by antibiotics alone, or in patients with neurological deterioration or sepsis. Multiple levels (cervical, thoracic, and lumbosacral) of epidural abscess can be successfully treated by limited lumbar laminectomy followed by using a small-bore catheter to drain the abscess. From 2007 to 2011, four patients with acute or subacute panspinal epidural abscesses (involving at least 15 vertebral levels from cervical to lumbosacral region) were successfully treated. Using the laminectomy as a portal, we used an 8-Fr infant nasogastric feeding tube to evacuate the epidural abscesses with gentle forward-backward motion and continuous suction-irrigation. All patients completed a 3- to 4-week course of parenteral antibiotics and continued oral antibiotics for 2 to 3 months until C-reactive protein levels and erythrocyte sedimentation rates returned to normal. Their Frankel scale all improved, and postoperative magnetic resonance imaging showed complete resolution of the epidural abscesses. No intraoperative dural perforations occurred. At the minimum 3-year followup, no neurological deficits or spinal instabilities were noted. We conclude that limited lumbar laminectomies combined with continuous suction-irrigation with an infant feeding tube within the cervicothoracolumbosacaral epidural space could be a safe and helpful method to treat panspinal epidural abscesses.
延伸閱讀
- Armanious, M., Bacon, L. N., Harris, J., George, S., Goulbourne, K. K., Danner, O. K., Matthews, L. R., & Wilson, K. L. (2013). Decompressive Laparotomy for Reduction of Incessant Increased Intracranial Pressure in the Absence of Abdominal Compartment Syndrome: A Case Report. International Journal of Case Reports and Images (IJCRI), 4(8), 419-422. https://doi.org/10.5348/ijcri-2013-08-346-CR-5
- Schulz, C., Kunz, U., Mauer, U. M., & R.Mathieu (2014). Early Postoperative Results after Removal of Cranially Migrated Lumbar Disc Prolapse: Retrospective Comparison of Three Different Surgical Strategies. Advances in Orthopedics, (2014), 137-142. https://doi.org/10.1155/2014/702163
- Wang, J. Y., Hsieh, J. S., Chen, F. M., Lee, L. W., Hou, M. F., Huang, Y. S., & Huang, T. J. (2002). Rectal Perforation Secondary to Surgical Drains After Low Anterior Resection : a Report of Two Case and Review of the Literature. The Kaohsiung Journal of Medical Sciences, 18(3), 146-148. https://doi.org/10.6452/KJMS.200203.0146
- Kevric, J., Aguirre, V., Martin, K., Varma, D., Fitzgerald, M., & Pilgrim, C. (2015). Peritoneal Breach as an Indication for Exploratory Laparotomy in Penetrating Abdominal Stab Injury: Operative Findings in Haemodynamically Stable Patients. Emergency Medicine International, 2015(), 57-61. https://doi.org/10.1155/2015/407173
- Tsai, C. H., Hsu, H. C., Chen, Y. J., Lin, C. J., & Chen, H. T. (2007). Recurrent Lumbar Disc Herniation after Discectomy: Clinical Result of Repeated Discectomy and Analysis of Factors Affecting Surgical Outcome. Mid-Taiwan Journal of Medicine, 12(3), 125-132. https://doi.org/10.6558/MTJM.2007.12(3).1