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KMID : 0359819760050010087
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Journal of Korean Neurosurgical Society
1976 Volume.5 No. 1 p.87 ~ p.91
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The Clinical Consideration for Spinal Epidural Abscess
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金康丘/Kim, Yong Goo
申光澈/李承洙/文明善/Shin, Kwang Chul/Lee, Sung Soo/Moon, Myoung Sun
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Abstract
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Infection involving the spinal cord and cauda equina are much less common than intracranial infection. Among the above, bacterial infection in spinal epidural space are relatively uncommon but well recognized entity in adult and children. More than 300 cases with, spinal epidural abcess are described in the literatures. Because of its rarity, there is delay in diagnosis and irreversible neurological sequelae in high percentage of cases.
Infection of the spinal epidural space are accompanied by fever, tachycardia; headache, pain anid tenderness in the back, weakness of the lower extremities and finally a complete paraplegia.
The modes of infection are 1) direct extension from inflammatory processe in adjacent tissues 2) perforating wounds or lumbar puncture 3) hematogenous route from the remote origin.
The most frequent causative organism is staphylococcus aureus always, but pneumococcus, streptococcus, pseudomonus, typhoid bacillus, pyocyanus, oidium coccidioides and fungus are causative organisms occasionally.
In spinal epidural abscess with complete paraplegia, the neurologic sequelae are permanent and unhappy. So the spinal epidural abscess is neurosurgical emergency in which early diagnosis and prompt surgery are necessary to avert permanent cord damage.
Recently, the spinal epidural abscess has increasing tendency. We have treated 5 cases with spinal epidural abscesses from Nov. 1974 to Apr. 1976.
The followings are results;
1) Sex incidence showed male 2, female 3 and age incidence ranged from 21 years to 38 years, but 4th decade was most common.
2) Most common mode of infection was unknown though all cases have been applied the acupunture. for the back pain several times.
3) Most available procedures of diagnosis were the usual infectious symptoms, leukocytosis, increased erythrocyte sedimentation rate, obstructive responce by Queckenstedt test and findings of myelography, including increased protein and pleocytosis in cerebrospinal fluid.
4) All 5 cases had been performed total laminectomy from Ta-L3, according to the lesions commonly in thoracic spine with spinal epidural abscess and had beentreated with penicillin G, Methicillin and Geopen.
5) The prognosis was poor in 4 cases with complete paraplegia but 1case with incomplete paralysis recovered completely.
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