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DOI: 10.1055/s-0038-1623040
Abscesso epidural raquiano: Análise de 15 casos
Spinal epidural abscess. Analysis of 15 casesPublication History
Publication Date:
11 January 2018 (online)
Resumo
Quinze pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e janeiro de 1996. Dez eram homens e 5, mulheres, com idade mediana de 50 anos. A associação de patologias que levam à imunodepressão, como diabetes e infecções, ocorreu em 67% dos casos. Todos os pacientes tinham dor na coluna vertebral, 11 apresentavam fraqueza muscular, 6 tinham parestesias e 5, alterações esfincterianas.
Dezesseis procedimentos cirúrgicos foram realizados nos 15 pacientes. Em 6 casos, o abscesso continha material francamente purulento; em 3, a coleção epidural apresentava-se como tecido de granulação e, em outros 4 casos, ambos estavam presentes. O Staphylococcus aureus foi isolado em 53% dos abscessos, e o bacilo da tuberculose em 20%. A coluna lombar foi comprometida em 8 casos e a cervical em 3.
O tratamento de escolha consiste na imediata drenagem cirúrgica do abscesso antes do desenvolvimento de déficit neurológico grave, combinado com antibioticoterapia específica.
Onze pacientes recuperaram suas funções neurológicas normais, e 4 permaneceram com alguma seqüela. Nesta série não ocorreu óbito.
Abstract
Fifteen patients with spinal epidural abscess were treated between January 1986 and January 1996. There were ten males and five females, with a median age of 50 years. Concurrent illness resulting in immunodepression, such as diabetes mellitus and infections, were present in 67% of the cases. All patients had back pain, eleven presented with muscle weakness, six had sensory deficit and five, bowel and/or bladder incontinence.
Sixteen surgical procedures were performed on fifteen patients. In six cases, the abscess consisted of frankly purulent material; in three, the epidural collection consisted of granulation tissue and both in other four cases. Staphylococcus aureus was isolated in 53% of the abscesses and BAAR in 20%. The lombar spine was the most affected region with a total of eight cases, followed by the cervical with three cases.
Immediate surgical drainage of the abscess, before the development of severe neurological deficit, combined with specific antibiotics remains the treatment of choice.
Eleven patients recovered their normal neurological function and four remained with some neurological disability. There was no death in this series.