單側(cè)雙通道脊柱內(nèi)鏡下椎間盤切除術(shù)及清創(chuàng)成功治療沙門氏菌性椎間盤炎及硬膜外膿腫罕見報(bào)告1例

Abstract

Spinal epidural abscess (SEA) is a rare but severe infection with potentially devastating consequences.  Epidural abscesses caused by Salmonella serogroup C2 are even rarer and tend to be more invasive with multidrug resistance.  Early diagnosis, effective use of antibiotics and surgical intervention are the mainstay strategies for managing SEA, especially for more virulent and multidrug-resistant Salmonella infections.  This case report presents a rare case of an elderly and fragile woman with Salmonella spondylodiscitis and an extensive epidural abscess, which were successfully treated with intravenous antibiotics and unilateral biportal endoscopic (UBE) debridement and drainage through four small surgical incisions.  After surgery, her fever subsided, she regained consciousness and her low back pain dramatically improved.  Follow-up magnetic resonance imaging showed complete resolution of the epidural abscess.  At 6 months after surgery, the patient regained muscle strength, ambulated with a walker and had no recurrence of the infection.  The UBE technique can effectively eradicate infection while minimizing surgery-related risks and complications.  A multidisciplinary team is required to achieve a good outcome.

摘要

脊髓硬膜外膿腫(SEA)是一種罕見的嚴(yán)重感染，具有潛在的破壞性后果。由沙門氏菌血清群C2引起的硬膜外膿腫甚至更罕見，往往具有更多的侵襲性和多藥耐藥。早期診斷、有效使用抗生素和手術(shù)干預(yù)是控制SEA的主要策略，特別是對于毒性更強(qiáng)和耐多藥的沙門氏菌感染。本病例報(bào)告是一例罕見的老年體弱婦女，因沙門氏菌性椎間盤炎及廣泛的硬膜外膿腫，經(jīng)靜脈注射抗生素及單側(cè)雙通道脊柱內(nèi)鏡(UBE)清創(chuàng)及四個(gè)小手術(shù)切口引流成功治療。手術(shù)后，退燒，恢復(fù)意識，腰痛明顯減輕。隨后的磁共振成像顯示硬膜外膿腫完全消失。術(shù)后6個(gè)月，患者恢復(fù)肌力，可行走，無感染復(fù)發(fā)。UBE技術(shù)可以有效根除感染，同時(shí)將手術(shù)相關(guān)的風(fēng)險(xiǎn)和并發(fā)癥降到極低。需要一個(gè)多學(xué)科的團(tuán)隊(duì)來實(shí)現(xiàn)良好的結(jié)果。