背景:由于缺乏诊断证据,临床课程,治疗,极为罕见的脊髓硬膜内脓肿(SIA)和脊髓硬膜外脓肿(SEA)患者的结局,我们对一组患者进行回顾性分析和比较,以确定这两种患者的表型.
方法:在20年的时间里,我们回顾性分析了78例SIA和SEA患者的电子病历.
结果:SIA患者入院时运动评分(MS评分)较差(SIA:20±26vs.SEA:75±34,p<0.001),更常出现共济失调步态(SIA:100%vs.SEA:31.8%,p<0.001),和更频繁的膀胱或肠功能障碍(SIA:91.7%vs.SEA:27.3%,p<0.001)与SEA患者相比。术中标本在SEA患者中的诊断敏感性高于SIA患者(SIA:66.7%vs.SEA:95.2%,p=0.024),但各种病原体,如金黄色葡萄球菌(SIA33.3%vs.SEA:69.4%),链球菌和肠球菌(SIA33.3%vs.SEA:8.1%,p=0.038)在两个实体中均检测到。SIA患者发生败血症的频率更高(SIA:75.0%vs.SEA:18.2%,p<0.001),脓毒性栓塞(SIA:33.3%vs.SEA:8.3%,p=0.043),威胁的迹象(SIA:100%vs.18.5%,p<0.001),脑室炎或脑脓肿(SIA:41.7%vs.SEA:3.0%,p<0.001),和肺炎(SIA:58.3%vs.SEA:13.6%,p=0.002)。手术后两组患者的平均MS评分均得到改善(SIA:20至35vs.SEA:75至90);然而,SIA患者出院时MS评分较差(SIA:35±44vs.SEA:90±20,p<0.001)。C反应蛋白(CrP)(SIA:159至49与SEA:189至27)和白细胞计数(SIA:15至9vs.SEA:14至7)在出院时减少。SIA患者的疾病相关死亡率较高(SIA:33.3%vs.SEA:1.5%,p=0.002),有更多的胸膜脓胸(SIA:58.3%vs.SEA:13.6%,p=0.002),需要一次以上的手术(SIA:33.3%vs.SEA13.6%,p=0.009),用静脉注射抗生素治疗的时间更长(7±4wvs.3±2w,p<0.001)和抗生素总体(12±10wvs.7±3w,p=0.022),并在医院呆了更多的时间(SIA:58±36vs.SEA:26±20,p<0.001)和重症监护病房(SIA:14±18vs.SEA:4±8,p=0.002)。
结论:我们的研究强调了两个实体之间不同的临床表型和结果,SIA患者在并发症和预后方面表现出明显较差的病程。
BACKGROUND: Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of both entities.
METHODS: Over a period of 20 years, we retrospectively analyzed the electronic medical records of 78 patients with SIA and SEA.
RESULTS: The patients with SIA showed worse motor scores (MS scores) on admission (SIA: 20 ± 26 vs. SEA: 75 ± 34, p < 0.001), more often with an ataxic gait (SIA: 100% vs. SEA: 31.8%, p < 0.001), and more frequent bladder or bowel dysfunction (SIA: 91.7% vs. SEA: 27.3%, p < 0.001) compared to the SEA patients. Intraoperative specimens showed a higher diagnostic sensitivity in the SEA patients than the SIA patients (SIA: 66.7% vs. SEA: 95.2%, p = 0.024), but various pathogens such as Staphylococcus aureus (SIA 33.3% vs. SEA: 69.4%) and Streptococci and Enterococci (SIA 33.3% vs. SEA: 8.1%, p = 0.038) were detected in both entities. The patients with SIA developed sepsis more often (SIA: 75.0% vs. SEA: 18.2%, p < 0.001), septic embolism (SIA: 33.3% vs. SEA: 8.3%, p = 0.043), signs of meningism (SIA: 100% vs. 18.5%, p < 0.001), ventriculitis or cerebral abscesses (SIA: 41.7% vs. SEA: 3.0%, p < 0.001), and pneumonia (SIA: 58.3% vs. SEA: 13.6%, p = 0.002). The mean MS score improved in both patient groups after surgery (SIA: 20 to 35 vs. SEA: 75 to 90); however, the SIA patients showed a poorer MS score at discharge (SIA: 35 ± 44 vs. SEA: 90 ± 20, p < 0.001). C-reactive protein (CrP) (SIA: 159 to 49 vs. SEA: 189 to 27) and leukocyte count (SIA: 15 to 9 vs. SEA: 14 to 7) were reduced at discharge. The SIA patients had higher rates of disease-related mortality (SIA: 33.3% vs. SEA: 1.5%, p = 0.002), had more pleural empyema (SIA: 58.3% vs. SEA: 13.6%, p = 0.002), required more than one surgery (SIA: 33.3% vs. SEA 13.6%, p = 0.009), were treated longer with intravenous antibiotics (7 ± 4 w vs. 3 ± 2 w, p < 0.001) and antibiotics overall (12 ± 10 w vs. 7 ± 3 w, p = 0.022), and spent more time in the hospital (SIA: 58 ± 36 vs. SEA: 26 ± 20, p < 0.001) and in the intensive care unit (SIA: 14 ± 18 vs. SEA: 4 ± 8, p = 0.002).
CONCLUSIONS: Our study highlighted distinct clinical phenotypes and outcomes between both entities, with SIA patients displaying a markedly less favorable disease course in terms of complications and outcomes.