Experience in diagnosis and treatment of 17 cases of primary intraspinal abscess
Objective To summarize the diagnosis and treatment experience of patients with primary intraspinal abscess,and provide reference for optimizing diagnosis and treatment.Methods A retrospective analysis was performed on 17 adult pa-tients with primary intraspinal abscess diagnosed and treated from May 2020 to January 2023.Two patients received non-surgical treatment,which included active treatment of underlying disease,immunity enhancement,correction of hypoprotein-emia,and adequate broad-spectrum antibiotic therapy.Fifteen patients received surgical treatment by posterior median ap-proach.Total laminectomy or semi-laminectomy was selected according to the location of the abscess.During the operation,at-tention was paid to protecting bilateral facet joints and removing abscess tissue as much as possible.The treatment plan was ad-justed in time according to the histopathological diagnosis and bacterial culture results.Results All intraspinal abscesses were located in the epidural,including 3 cases in the thoracic spine segment,5 cases in the thoracolumbar spine segment,2 cases in the lumbar spine segment,and 7 cases in the lumbosacral spine segment.One case of pus culture was positive,and the result was group B streptococcus(Streptococcus agalactis).Four cases were pathologically diagnosed as spinal tuberculosis,and re-ceived standardized anti-tuberculosis treatment for 18 months.All the 17 cases were followed up for 6 to 24 months(mean 10.3 months).At the last follow-up,all patients'symptoms of low back pain,radiating pain and numbness of lower limbs were com-pletely relieved,and their temperature returned to normal.The 2 patients who underwent non-surgical treatment were all cured,pain and numbness of both lower limbs were relieved,and muscle strength was grade 5.Of the 15 cases treated by operation,11 cases were cured,2 cases recovered from grade 4 to grade 5-,1 case recovered from grade 3 to grade 4+,and 1 case had re-sidual stool dysfunction.Conclusion Primary intraspinal abscess usually occurs in the lumbosacral segment and thoracolumbra segment.Pain,fever and lower limb nerve function injury are the main clinical manifestations of patients.Patients should re-ceive early surgical treatment and broad-spectrum antibiotics in sufficient amount.Patients who cannot tolerate surgery or can-not be operated on for other reasons can be treated with non-surgical treatment,and the neurological function of patients should be closely observed during non-surgical treatment.
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