方法:系统评价。
目的:过去的研究表明,胸段脊柱硬膜外脓肿(SEAs)的进展速度和严重程度增加,具体来说,与其他脊髓水平的SEA相比。未治疗,如果管理不当,这种感染可导致永久性神经系统后遗症,最终进展至死亡.尽管这种疾病很严重,没有文章关注演讲,诊断,和胸部水平的SEA的治疗。出于这个原因,在研究人员设计和实施以下系统评价时,特别关注胸部水平的SEA。
方法:Ovid-Medline和EMBASE的查询,CochraneCentral,并进行了额外的审查来源。搜索标准集中于胸部硬膜外脓肿的文章。
结果:25篇文章符合纳入标准。入院时最常见的症状包括背痛,截瘫/截瘫,发烧,和肠/膀胱控制的丧失。重要的危险因素包括糖尿病,静脉注射毒品,和高龄(P=0.001)。患者最常采用椎板切除术进行手术治疗,半椎板切除术,或彻底减压清创术。出现神经功能缺损并在抗生素治疗失败后延迟手术干预的患者与立即接受手术治疗的患者相比,往往表现更差(P<.005)。
结论:研究人员首次专门关注胸部水平的SEAs,与以前发表的对整个海域的一般分析相反。根据结果,研究者推荐脊柱的早期磁共振成像,实验室检查(沉降速率/C反应蛋白,全血细胞计数),脓肿培养,然后是经验性抗生素,并在出现神经功能缺损时立即进行手术减压。
METHODS: Systematic
review.
OBJECTIVE: Past research has demonstrated increased speed and severity of progression for spinal epidural abscesses (SEAs) of the thoracic level, specifically, when compared with SEAs of other spinal cord levels. Untreated, this infection can result in permanent neurological sequelae with eventual progression to death if inadequately managed. Despite the seriousness of this disease, no articles have focused on the presentation, diagnosis, and treatment of SEAs of the thoracic level. For this reason, specific focus on SEAs of the thoracic level occurred when researchers designed and implemented the following systematic
review.
METHODS: A query of Ovid-Medline and EMBASE, Cochrane Central, and additional
review sources was conducted. Search criteria focused on articles specific to thoracic epidural abscesses.
RESULTS: Twenty-five articles met inclusion criteria. The most commonly reported symptoms present on admission included back pain, paraparesis/paraplegia, fever, and loss of bowel/bladder control. Significant risk factors included diabetes, intravenous drug use, and advanced age (P = .001). Patients were most often treated surgically with either laminectomy, hemilaminectomy, or radical decompression with debridement. Patients who presented with neurological deficits and had delayed surgical intervention following a failed antibiotic course tended to do worse compared with their immediate surgical management counterparts (P < .005).
CONCLUSIONS: For the first time researchers have focused specifically on SEAs of the thoracic level, as opposed to previously published general analysis of SEAs as a whole. Based on the results, investigators recommend early magnetic resonance imaging of the spine, laboratory workup (sedimentation rate/C-reactive protein, complete blood count), abscess culture followed by empiric antibiotics, and immediate surgical decompression when neurological deficits are present.