PDF(Pubmed)
Abstract：
OBJECTIVE: Thoracic spinal epidural abscess (SEA) is a rare but dangerous condition, and traditional surgical methods are accompanied by extensive trauma and approach-related complications. Here we introduce the technique of full-endoscopic transforaminal debridement and decompression and evaluate its feasibility for treating brucellar thoracic SEA.
METHODS: We performed thoracic full-endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented.
RESULTS: There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2-year follow-up, one patient achieved complete recovery (from Frankel-C to Frankel-E), while another patient improved from Frankel-A to Frankel-D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity.
CONCLUSIONS: We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery.
METHODS: We performed thoracic full-endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented.
RESULTS: There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2-year follow-up, one patient achieved complete recovery (from Frankel-C to Frankel-E), while another patient improved from Frankel-A to Frankel-D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity.
CONCLUSIONS: We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery.
摘要：
目的：胸椎硬膜外脓肿（SEA）是一种罕见但危险的疾病，传统的手术方法伴随着广泛的创伤和入路相关的并发症。在这里，我们介绍了全内窥镜经椎间孔清创减压技术，并评估了其治疗胸膜下SEA的可行性。
方法：我们对2例由布鲁氏SEA引起的神经功能缺损患者进行了胸腔镜下经椎间孔减压和清创，主要由肉芽组织而不是脓液组成。进行术后MRI以确认存在任何残余脓肿压迫神经。采用Frankel分级评估神经功能恢复情况,并记录了并发症。
结果：没有出现硬脑膜撕裂，术后血肿,或肺部并发症。术后神经功能明显改善,术后MRI证实无残余脓肿压迫脊髓。在为期两年的随访中，一名患者实现完全康复（从Frankel-C到Frankel-E），而另一名患者从Frankel-A改善到Frankel-D。患者均未出现感染复发，不稳定性,也没有后凸畸形。
结论：我们描述了经椎间孔镜手术在胸椎肉芽肿性SEA中的新应用，并初步表明了该技术作为开放手术的微创替代方法的可行性。
方法：我们对2例由布鲁氏SEA引起的神经功能缺损患者进行了胸腔镜下经椎间孔减压和清创，主要由肉芽组织而不是脓液组成。进行术后MRI以确认存在任何残余脓肿压迫神经。采用Frankel分级评估神经功能恢复情况,并记录了并发症。
结果：没有出现硬脑膜撕裂，术后血肿,或肺部并发症。术后神经功能明显改善,术后MRI证实无残余脓肿压迫脊髓。在为期两年的随访中，一名患者实现完全康复（从Frankel-C到Frankel-E），而另一名患者从Frankel-A改善到Frankel-D。患者均未出现感染复发，不稳定性,也没有后凸畸形。
结论：我们描述了经椎间孔镜手术在胸椎肉芽肿性SEA中的新应用，并初步表明了该技术作为开放手术的微创替代方法的可行性。
