小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热
- 脊椎疼痛或压痛
- 四肢无力
- 麻痹
- 感觉障碍
- 反射异常
其他诊断因素
- 单独括约肌功能障碍
危险因素
- 静脉毒品使用
- 近期脊柱手术或创伤
- 留置脊髓导管
- 邻近部位的局部感染
- 免疫抑制
- 糖尿病
- 慢性肾病
- 伴发菌血症或心内膜炎
- 酒精滥用
- 男性
- 肥胖
- 非邻近部位的合并感染（不包括细菌感染）
- 慢性肝病
诊断性检查
首要检查
- 全血细胞计数（FBC）
- C 反应蛋白 (CRP)
- 红细胞沉降率
- 含和不含静脉注射造影剂的脊柱 MRI
- 血培养
需考虑的检查
- 直接脓肿抽吸进行培养
- 抽吸物的聚合酶链反应（PCR）
治疗流程
疑似硬膜外脓肿
甲氧西林敏感金黄色葡萄球菌（MSSA） 感染
MRSA 感染
革兰氏阴性菌感染
合并结核杆菌感染
撰稿人
作者
Kenneth F. Casey, MD
Associate Adjunct Professor
Clinical Associate Professor of Physical Medicine and Rehabilitation
Wayne State University School of Medicine
Clinical Associate Professor Surgery (Neurosurgery)
Michigan State University
Detroit
MI
利益声明
KFC is a member of the Medical Advisory Board Facial Pain Association, an editor of the Medicine online journal, and a reviewer for World Neurosurgery (all unpaid), and teaches at Michigan State and Wayne State Volunteer faculty.
Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHE
Chair
Department of Medicine
Mercy Hospital-St. Louis
St. Louis
MO
利益声明
FAM is an author of references cited in this topic.
同行评议者
John M. Embil, MD, FRCPC
Consultant
Infectious Diseases
Associate Professor
Section of Infectious Diseases
Department of Medicine
University of Manitoba
Director
Infection Prevention and Control Unit Health Sciences Centre
Winnipeg
Manitoba
Canada
利益声明
JME declares that he has no competing interests.
Iain Christie, MB BhB, FRCA
Consultant Anaesthetist
Derriford Hospital
Plymouth
UK
利益声明
IC declares that he has no competing interests.
Wendy Ziai, MD, MPH
Assistant Professor
Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine
The Johns Hopkins University
Baltimore
MD
利益声明
WZ declares that she has no competing interests.
参考文献
关键文献
Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. 2016 Dec 1 [Epub ahead of print].全文 摘要
Sharfman ZT, Gelfand Y, Shah P, et al. Spinal epidural abscess: a review of presentation, management, and medicolegal implications. Asian Spine J. 2020 Oct;14(5):742-59.全文 摘要
Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008 Jan;101(1):1-12.全文 摘要
Expert Panel on Neurological Imaging., Ortiz AO, Levitt A, et al. ACR Appropriateness Criteria® Suspected spine infection. J Am Coll Radiol. 2021 Nov;18(suppl 11):S488-501.全文 摘要
Suppiah S, Meng Y, Fehlings MG, et al. How best to manage the spinal epidural abscess? A current systematic review. World Neurosurg. 2016 Sep;93:20-8. 摘要
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- 硬膜外血肿
- 多发性硬化
- 恶性脊髓压迫症
更多 鉴别诊断指南
- ACR 适宜性标准：疑似脊柱感染
- 关于在感染性疾病诊断时使用微生物学实验室检查的指导
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