Article
Cervical spine epidural abscess evacuated via an oblique corpectomy: Report on three cases
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Authors
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M. Prokopienko
- Department of Neurosurgery, Medical University of Warsaw, Poland
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P. Kunert
- Department of Neurosurgery, Medical University of Warsaw, Poland
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A. Marchel
- Department of Neurosurgery, Medical University of Warsaw, Poland
| Published: | April 28, 2011 |
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Outline
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Objective: Aggressive decompression with subsequent internal stabilization in purulent osteomyelitis causing epidural abscess is controversial because of the risk of persistent infection of bone grafts and artificial implants. Recent literature indicates a growing contribution of minimally invasive approaches without internal fixation. We report on three patients harboring ventral cervical epidural abscess evacuated via an oblique corpectomy without fusion.
Methods: Two women and one man, ranging in age from 36 to 90 were operated by oblique corpectomy because of cervical spondylodiscitis with epidural abscess in our department over the past 6 years. Two of them had severe comorbid conditions including diabetes, hypertension, heart failure and atrial fibrillation. All patients presented with symptoms of progressively increasing myelopathy, including the oldest patient, who rapidly deteriorated to tetraplegia. In all the cases oblique corpectomy on two vertebral levels was performed, followed by pus evacuation in two and debridement of granulation tissue in one. Rinsing drainage of the epidural space was used and intravenous antibiotic therapy was administered in all patients. Follow-up ranged from 3 days to 6 years.
Results: The neurological status of two patients improved significantly after surgery and one patient died. The oldest patient with many concomitant diseases died from a sudden cardiac arrest on the 3rd postoperative day. Up to now no internal stabilization was needed in the remaining two patients but in one nonsignificant kyphosis of the cervical spine occurred. At the last follow-up examination a full recovery was found in one, and a minor residual deficit in another.
Conclusions: To our knowledge the use of oblique corpectomy has not been previously described for this entity. Our limited series does not allow us to draw far-reaching conclusions but this approach has some advantages. It does not affect anterior and posterior column, however it gives a broad view on the ventral aspect of the spinal canal. Therefore, adequate spinal cord decompression together with granulation removal is possible without sacrificing spinal stability.
