화농성 척수 경막외 농양 10예의 치험

Abstract

Spinal epidural abscess is a rare disorder with poor prognosis. In order to understand its clinical feature and method of treatment, a retrospective study of spinal epidural abscess spanning 8 years and encompassing 10 patients was done. There were 6 males and 4 females aged 12 to 64 years with peak incidence at the sixth decade. In one patient, epidural abscess recurred at the site previously treated 10 years ago. In addition to fever and leukocytosis in 8 patients, other frequent symptoms according to lesion site were abdominal pain and motor weakness in thoracic epidural abscess and low back pain and sciatica in lumbar epidural abscess. Staphylococcus aureus was the most common causative organism. Magnetic resonance imaging(MRI) showed variable signal on T1-weighted images and hyperintensity on T2-weighted images, which was studied in 6 patients. Two patterns in gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhancement(2 patients) and heterogeneous enhancement(4 patients). MRI offered the advantage of noninvasive early recognition and anatomical localization, which made it the imaging modality of choice. Although laminectomy was the standard operative procedure, the result of window laminectomy with catheter drainage for prevention of kyphosis was proven effective in a girl. Complete improvement following surgery was obtained in 8 patients, while a man resulted in paraplegia and a boy paraparesis with mild kyphosis in thoracic abscess as sequelae.

저자들은 최근 8년간 치료한 화농성 척추 경막외 농양 10예들을 분석한 결과 50대에 가장 호발하여 흉요추부에 호발하였다. 주요증상은 흉추부에 발생 시엔 급하게 진행하는 복통과 양하지 마비였으며 요추부에 발생 시엔 비교적 장기간의 요통 및 하지 방사성 통증이었다. MRI가 가장 좋은 진단방법으로서 대조강화 소견은 비균일 대조강화 소견과 주변부 윤상의 대조강화소견으로 나타났다. Staphylococcus aureus가 가장 흔한 균주이며 광범위한 부위에 걸쳐있는 농양인 경우엔 제한된 후궁절제 후 배농만으로도 좋은 결과를 얻을 수 있겠다. 만성 결절성 농양은 종양처럼 완전 제거가 가능하였다. 치료 후 결과는 비교적 양호하였다.