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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Realizar un estudio sobre los casos de empiema epidural espinal atendidos en los &#250;ltimos 20 a&#241;os y practicar una revisi&#243;n de la literatura sobre la patogenia&#44; diagn&#243;stico y tratamiento de estas lesiones&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio retrospectivo descriptivo sobre 14 casos de empiemas epidurales espinales&#46; Se analizaron las caracter&#237;sticas epidemiol&#243;gicas b&#225;sicas&#44; manifestaciones cl&#237;nicas&#44; datos anal&#237;ticos&#44; t&#233;cnicas de diagnostico&#44; actitudes terap&#233;uticas usadas y los resultados obtenidos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La serie esta formada por 7 varones y 7 mujeres con edades que oscilaron entre 8 y 76 a&#241;os &#40;media 48&#46;9&#41;&#46; En 12 casos el s&#237;ntoma de presentaci&#243;n fue la presencia de dolor vertebral local&#44; siempre en relaci&#243;n con la localizaci&#243;n del empiema&#44; siendo la duraci&#243;n media de la sintomatolog&#237;a de 9&#46;3 d&#237;as&#46; La velocidad de sedimentaci&#243;n globular &#40;VSG&#41; estaba elevada en todos los casos y exist&#237;a leucocitosis en trece pacientes &#40;92&#46;9&#37;&#41;&#46; En 11 casos &#40;78&#46;5&#37;&#41;&#44; la localizaci&#243;n del empiema fue en la regi&#243;n dorsal&#46; Trece pacientes fueron tratados mediante cirug&#237;a y uno recibi&#243; exclusivamente tratamiento antibi&#243;tico&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En pacientes con factores de riesgo &#40;inmunosupresi&#243;n&#44; diabetes&#41;&#44; la presencia de dolor espinal asociado a fiebre y alteraciones anal&#237;ticas &#40;leucocitosis&#47;elevaci&#243;n de la VSG&#41;&#44; deben ser estudiados con resonancia magn&#233;tica espinal&#44; ante el riesgo de desarrollar un empiema epidural&#46; El tratamiento de elecci&#243;n es la combinaci&#243;n de la evacuaci&#243;n quir&#250;rgica urgente y pauta antibi&#243;tica&#44; ya que la demora en el tratamiento puede ocasionar lesiones neurol&#243;gicas irreversibles&#46; El tratamiento exclusivamente m&#233;dico debe s&#243;lo reservarse para pacientes con elevado riesgo quir&#250;rgico o que no presenten afectaci&#243;n neurol&#243;gica&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The goal of this study was to review our series of spinal epidural empyema diagnosed in the last 20 years and review the literature regarding the pathogenesis&#44; diagnosis and treatment of these lesions&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective study over 14 patients diagnosed of spinal epidural empyema&#46; We review the epidemiological data&#44; clinical symptoms&#44; laboratory and imaging data&#44; the treatment r&#233;gimen and the results&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Fourteen patients&#44; 7 males and 7 females&#44; with an age range from 8 to 76 years &#40;mean 48&#46;9&#41; were identified&#46; The first symptom was localized back&#47;neck pain in 12 patients and the mean duration of symptoms was 9&#46;3 days&#46; Erythrocyte sedimentation rate &#40;ESR&#41; was elevated in all patients&#59; peripheral leukocyte count was elevated in 13 cases &#40;92&#46;9&#37;&#41;&#46; Site of spinal epidural empyemas was distributed along the axis but in 11 cases the location was thoracic&#46; Thirteen patients had surgery for debridement and spinal decompression and one patient was treated successfully with antibiotics alone&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients with localized back pain and fever who are at risk for developing such empyemas with elevation of white blood cells and increased ESR&#44; should have an immediate magnetic resonance imaging sean&#46; Urgent surgical drainage and antibiotic use are the treatment of choice in order to prevent irreversible neurological d&#233;ficits&#46; Nonsurgical treatment should be reserved for poor surgical candidates and patients without neurological d&#233;ficits&#46;</p>"
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Vol. 15. Núm. 6.
Páginas 543-551 (enero 2004)
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Vol. 15. Núm. 6.
Páginas 543-551 (enero 2004)
Empiema epidural espinal. Análisis de 14 casos
Spinal epidural empyema. Analysis of 14 cases
Visitas
4337
M. Gelabert-González
, J. González-García, J.M. Fernández-Villa, A. GarcíaAllut, R. Martínez-Rumbo
Servicio de Neurocirugía. Hospital Clínico Universitario de Santiago. Departamento de Cirugía. Universidad de Santiago de Compostela
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Estadísticas
Resumen
Objetivos

Realizar un estudio sobre los casos de empiema epidural espinal atendidos en los últimos 20 años y practicar una revisión de la literatura sobre la patogenia, diagnóstico y tratamiento de estas lesiones.

Pacientes y métodos

Se trata de un estudio retrospectivo descriptivo sobre 14 casos de empiemas epidurales espinales. Se analizaron las características epidemiológicas básicas, manifestaciones clínicas, datos analíticos, técnicas de diagnostico, actitudes terapéuticas usadas y los resultados obtenidos.

Resultados

La serie esta formada por 7 varones y 7 mujeres con edades que oscilaron entre 8 y 76 años (media 48.9). En 12 casos el síntoma de presentación fue la presencia de dolor vertebral local, siempre en relación con la localización del empiema, siendo la duración media de la sintomatología de 9.3 días. La velocidad de sedimentación globular (VSG) estaba elevada en todos los casos y existía leucocitosis en trece pacientes (92.9%). En 11 casos (78.5%), la localización del empiema fue en la región dorsal. Trece pacientes fueron tratados mediante cirugía y uno recibió exclusivamente tratamiento antibiótico.

Conclusiones

En pacientes con factores de riesgo (inmunosupresión, diabetes), la presencia de dolor espinal asociado a fiebre y alteraciones analíticas (leucocitosis/elevación de la VSG), deben ser estudiados con resonancia magnética espinal, ante el riesgo de desarrollar un empiema epidural. El tratamiento de elección es la combinación de la evacuación quirúrgica urgente y pauta antibiótica, ya que la demora en el tratamiento puede ocasionar lesiones neurológicas irreversibles. El tratamiento exclusivamente médico debe sólo reservarse para pacientes con elevado riesgo quirúrgico o que no presenten afectación neurológica.

Palabras clave:
Absceso epidural espinal
Empiema epidural espinal
Laminectomía
Infección espinal
Resonancia magnética
Abreviaturas:
EEE
PCR
VSG
Summary
Objective

The goal of this study was to review our series of spinal epidural empyema diagnosed in the last 20 years and review the literature regarding the pathogenesis, diagnosis and treatment of these lesions.

Patients and methods

This is a retrospective study over 14 patients diagnosed of spinal epidural empyema. We review the epidemiological data, clinical symptoms, laboratory and imaging data, the treatment régimen and the results.

Results

Fourteen patients, 7 males and 7 females, with an age range from 8 to 76 years (mean 48.9) were identified. The first symptom was localized back/neck pain in 12 patients and the mean duration of symptoms was 9.3 days. Erythrocyte sedimentation rate (ESR) was elevated in all patients; peripheral leukocyte count was elevated in 13 cases (92.9%). Site of spinal epidural empyemas was distributed along the axis but in 11 cases the location was thoracic. Thirteen patients had surgery for debridement and spinal decompression and one patient was treated successfully with antibiotics alone.

Conclusions

Patients with localized back pain and fever who are at risk for developing such empyemas with elevation of white blood cells and increased ESR, should have an immediate magnetic resonance imaging sean. Urgent surgical drainage and antibiotic use are the treatment of choice in order to prevent irreversible neurological déficits. Nonsurgical treatment should be reserved for poor surgical candidates and patients without neurological déficits.

Key words:
Laminectomy
Magnetic resonance imaging
Spinal epidural abscess
Spinal epidural empyema
Spinal infection

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