• Ching-Yu Lee, Pei-Chin Chen, Meng-Huang Wu, Tsung-Jen Huang, Chun-Chao Chang, Po-Yao Wang, and Yuarn-Jang Lee.
• Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
• World Neurosurg. 2022 Dec 1; 168: 111119111-119.

BackgroundAn extensive spinal epidural abscess is a devasting infection of the multiple-level epidural space. Emergent surgical decompression is required to remove the abscess and decompress the affected spinal cord. This study evaluated the efficacy of unilateral laminotomy for bilateral decompression (ULBD) in the treatment of extensive spinal epidural abscesses.MethodsThree patients with extensive spinal epidural abscesses (epidural abscess involving more than 5 vertebral levels) were treated with the ULBD technique between September 2019 and August 2020. An ultrasonic curette was used for over-the-top decompression. Surgical drainage of the epidural abscess was performed concurrently with sublaminar drilling on top of the dura sac by using cold saline to automatically maintain the effluent in the ultrasonic curettage device.ResultsThe 3 patients were men, with a mean age of 65.7 years. Diabetes mellitus, fever, and paraplegia were reported in all 3 patients. Escherichia coli, Staphylococcus aureus, and Streptococcus intermedius were cultured separately. The mean operative time was 163 minutes, and the mean estimated blood loss was 160 mL. All patients fully recovered from neurologic deficits and returned to preinjury levels of functioning at the final follow-up.ConclusionsAs a minimally invasive technique, ULBD is a safe and effective treatment for extensive spinal epidural abscesses in critically ill patients. Moreover, the use of an ultrasonic bone curette not only safely accelerates over-the-top decompression but also flushes the epidural abscess with copious amount of cold saline.Copyright © 2022 Elsevier Inc. All rights reserved.

16 keywords...

hide…