Diagnosis features of thoracic spinal epidural abscess without fever and review of literature
Ma Longfei1，Zhang Xu2，Kong Xiangqing2，Wang Yexin2，Meng Chunyang2
1Graduate School of Jining Medical University,Jining 272067，China；2Department of Spine Surgery，Affiliated Hospital of Jining Medical University，Jining 272029，China
Abstract：ObjectiveTo explore the diagnosis features of spinal epidural abscess (SEA).MethodsThe clinical data of 1 case of SEA without fever was analyzed retrospectively.Literatures were reviewed and features of clinical diagnosis of SEA were summarized.ResultsThe patient was an old man,and was admitted to department of spine surgery of Affiliated Hospital of Jining Medical University for low back pain and paralysis of lower limbs.He had a history of diabetes mellitus for more than 3 years without taking medicine to control his blood sugar.On admission,his body temperature was 36.8℃,blood sugar 8.2mmol/L,initial whitecell count 10.80×109/L (83.60% neutrophils),and serum C-reactive protein 82mg/L.MRI revealed abnormal high signal in T7-11 segment of intraspinal epidural space at admission.Decompressive laminectomy was performed urgently.During the operation,the white viscous pus in the spinal canal was observed and the pus was taken for bacterial culture.The result of bacterial culture was Staphylococcus aureus.Postoperative MRI scan which performed on the nineteenth day after surgery revealed the spine has been decompressed successfully.After 10 months follow-up,the lower limbs recovered.ConclusionsClinically,SEA is an uncommon disorder,and the early diagnosis of SEA is difficult,especially SEA without fever.The accurate diagnosis needs a combination of clinician experience,clinical manifestation in patients,laboratory examination and imaging assays.Patients with diabetes mellitus are the highest risk subgroup of SEA.When the diabetic patients with low back pain and the increase of inflammatory markers,spinal epidural abscess should be considered,although patient′s body temperature is normal.And further,MRI should be carried out to clarify the diagnosis.
马龙飞1章旭2孔祥清2王叶新2孟纯阳2. 无发热胸椎段硬脊膜外脓肿临床诊断学特征并文献复习[J]. 中华诊断学电子杂志, 2017, 5(4): 253-256.
Ma Longfei1，Zhang Xu2，Kong Xiangqing2，Wang Yexin2，Meng Chunyang2. Diagnosis features of thoracic spinal epidural abscess without fever and review of literature. zhzdx, 2017, 5(4): 253-256.
