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Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy: a rare case report with literature review.
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2019-07-02 , DOI: 10.1038/s41394-019-0206-8 Kaustubh Ahuja 1 , Lakshmana Das 1 , Aakriti Jain 1 , Pradeep Kumar Meena 1 , Shobha S Arora 1 , Pankaj Kandwal 1
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2019-07-02 , DOI: 10.1038/s41394-019-0206-8 Kaustubh Ahuja 1 , Lakshmana Das 1 , Aakriti Jain 1 , Pradeep Kumar Meena 1 , Shobha S Arora 1 , Pankaj Kandwal 1
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Introduction
Holocord spinal cord epidural abscess is an uncommon condition that may result in serious neurological complications. Prompt diagnosis and early treatment is of paramount importance for an optimum clinical outcome. This case report describes a novel technique of interval laminectomy at two sites in the thoracic spine and surgical decompression with the help of infant feeding tubes in a case of holocord spinal epidural abscess (HSEA).
Case presentation
An 18-year-old male presented to the emergency department with high-grade fever and low back ache of 2 weeks duration and loss of bowel and bladder control for 4 days. Neurological examination revealed intact motor power and sensation in all four limbs at presentation; however, there was a rapid deterioration to complete quadriplegia within 24 h. A diagnosis of holocord epidural abscess was made. Emergent decompression via interval thoracic laminectomy was done and appropriate antimicrobial therapy was instituted. At 10 months of follow-up, the individual showed complete neurological recovery.
Discussion
The technique used in this case is unique with respect to the level of laminectomy and the manoeuvre employed for pus evacuation. Complete neurological and functional recovery was achieved despite complete paralysis pre-operatively. The outcome indicates that there may be good prognosis for individuals with HSEA accompanied with neurological deficit and emergent surgical decompression.
中文翻译：
双胸椎间隔椎板切除术清除脊髓全息硬膜外脓肿：罕见病例报告及文献综述。
简介 Holocord 脊髓硬膜外脓肿是一种罕见的疾病，可能会导致严重的神经并发症。及时诊断和早期治疗对于获得最佳临床结果至关重要。本病例报告描述了一种新技术，即在全脊髓硬膜外脓肿 (HSEA) 病例中，在胸椎两个部位进行间隔椎板切除术，并在婴儿饲管的帮助下进行手术减压。病例介绍 一名 18 岁男性因高烧、腰痛持续 2 周、大小便失禁 4 天而被送往急诊科。神经学检查显示就诊时所有四肢的运动能力和感觉均完好；然而，病情迅速恶化，在 24 小时内完全瘫痪。诊断为全脐硬膜外脓肿。通过间隔胸椎板切除术进行紧急减压，并采取适当的抗菌治疗。 10 个月的随访后，该患者的神经功能完全恢复。讨论 本例中使用的技术在椎板切除术水平和脓液排出操作方面是独特的。尽管术前完全瘫痪，但仍实现了神经和功能的完全恢复。结果表明，伴有神经功能缺损和紧急手术减压的 HSEA 患者可能有良好的预后。
更新日期：2019-11-18
中文翻译：
双胸椎间隔椎板切除术清除脊髓全息硬膜外脓肿：罕见病例报告及文献综述。
简介 Holocord 脊髓硬膜外脓肿是一种罕见的疾病，可能会导致严重的神经并发症。及时诊断和早期治疗对于获得最佳临床结果至关重要。本病例报告描述了一种新技术，即在全脊髓硬膜外脓肿 (HSEA) 病例中，在胸椎两个部位进行间隔椎板切除术，并在婴儿饲管的帮助下进行手术减压。病例介绍 一名 18 岁男性因高烧、腰痛持续 2 周、大小便失禁 4 天而被送往急诊科。神经学检查显示就诊时所有四肢的运动能力和感觉均完好；然而，病情迅速恶化，在 24 小时内完全瘫痪。诊断为全脐硬膜外脓肿。通过间隔胸椎板切除术进行紧急减压，并采取适当的抗菌治疗。 10 个月的随访后，该患者的神经功能完全恢复。讨论 本例中使用的技术在椎板切除术水平和脓液排出操作方面是独特的。尽管术前完全瘫痪，但仍实现了神经和功能的完全恢复。结果表明，伴有神经功能缺损和紧急手术减压的 HSEA 患者可能有良好的预后。
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