Spinal Epidural Abscess Presenting as Lower Back Pain: A Case Report and Literature Review

以下背痛表現的脊椎硬膜外膿瘍：病例報告

汪作良(Tso-Liang Wang) ； 陳信穎(Hsin-Ying Chen) ； 沈永訓(Young-Shung Shen)

《中華民國復健醫學會雜誌》 21期 (1993/12) Pp. 161-166

摘要

脊椎硬膜外膿瘍(Spinal Epidural Abscess)為一相當罕見的神經系統感染疾病。其發生率國內尚無統計報告。根據美國數個醫學中心發表之統計，每10000住院人次中僅有0.2至1.2人次。因其罕見，往往造成診療之延誤。
本文報告一例57歲具有糖尿病史的中年婦女，主訴嚴重下背痛約一週，具神經根症狀，但無發燒、畏寒、倦怠、嗜中性球過多等感染表現，且對復健治療反應不佳。核磁共振掃描(MRI)發現脊椎硬膜外有T2強度訊號增加之塊狀病灶(自第三、四腰椎間至第一薦椎)。病患接受第三、四腰椎椎板切除術與膿瘍引流，並投予強效抗生素。病原菌為金黃色葡萄球菌。術後病患症狀緩解且無任何神經學後遺症。
下背痛是復健科門診常見的主訴，若患者病程不典型、對治療反應不佳，感染疾患雖罕見但務必列入鑑別診斷。核磁共振掃描常可提供優良訊息。尤其糖尿病患者，免疫能力降低，感染徵象不明顯，更須詳加檢查，以免延誤病情。

並列摘要

Spinal epidural abscess (SEA) is a rare infectious disorder often subject to a delayed diagnosis. In two United States hospitals, the incidence was between 0.2 and 1.2 per 10000 admissions. There are still no reports about the incidence of SEA in Taiwan. In this report, we present a 57-year-old diabetic woman who suffered from severe lower back pain for one week prior to admission. Neither physical infectious signs nor obvious neutrophilia was apparent.
The responses to electrotherapy and nonsteroidal anti-inflammatory drugs were poor. The result of magnetic resonance imaging (MRI) study demondtrated an epidural soft tissue mass extemding from the L3-4 to S1 vertebral level. Decompressive hemiaminectomy from L3 to L5 with pus drainage from the epidural space was performed and followed by administration of antibiotics. The pathogen was proven to be Staphylococcus aureus. The symptoms were relieved after surgery and there was no residual neruological deficit.
Lower back pain is a common clinical complaint. This infectious disorder, though rare, should be considered as a possibility if patients have an atypical clinical course and poor reponse to treatment. MRI can offer reliable information for diagnosis. More care should be taken with diabetic patients who have decreased immune function for fear of delayed diagnosis and management.

並列關鍵字

spinal epidrual abscess