Spinal anestezi sonrası nadir görülen bir komplikasyon; spinal epidural abse
Spinal epidural abse (SEA), nadir görülen ve erken tanı konulup tedavi edilmezse ciddi nörolojik hasara hatta ölüme neden olabilen enfeksiyöz bir omurga hastalığıdır. 73 yaşında, 70 kg ağırlığındaki erkek hasta gaita inkontinansı, sağ bacakta güçsüzlük ve yürüyememe şikayetleri ile anestezi polikliniğine başvurdu. 13 gün önce inguinal herni ameliyatı nedeniyle hastaya L3-4 aralığından spinal anestezi uygulandığı öğrenildi. Klinik bulgular ve Magnetik Rezonans Görüntüleme (MRG) sonucunda SEA tanısı konulan hastanın genel durum bozukluğu ve nörolojik bulguların varlığı nedeniyle cerrahi tedavi uygulanmasına karar verildi. Beyin cerrahisi kliniği tarafından L3 seviyesine parsiyel ve L4 seviyesine total laminektomi yapıldı. Postoperatif dönemde hastanın gaita inkontinansı ve güç kaybı düzeldi. Spinal anestezi uygulanmış, sırt ağrısı olan ve enflamatuar parametreleri artmış hastalarda SEA mutlaka akla getirilmesi gereken ciddi bir klinik tablodur.
A rare complıcatıon after spınal anasthesıa; spınal epıdural abscess
Spinal epidural abscess (SEA), is a rare and serious vertebral disease causing severe neurological deficit and mortality if not treated. 73 years old male patient was admitted to the outpatient clinic of anesthesia with the complaints of fecal incontinence, loss of strength in right leg and difficulty in walking. His medical history was significant as spinal anesthesia was performed between L3 and L4 level for inguinal hernia surgery 13 days before. SEA was diagnosed with clinical findings and magnetic resonance imaging, and surgical treatment was considered due to impaired general health status and neurological findings. Total laminectomy at the level of L4 and partial laminectomy at the level of L3 were performed. Fecal incontinence and muscle strength were improved during postoperative period. SEA is a serious clinical case that should be considered in patients with back pain and increased inflammatory parameters, and who have had spinal anaesthesia.
___
- 1.Köksal V, Güçer H. Sa¤lkl Bir nsanda Progresif Paraparezi ile Ortaya Çıkan Torakal Spinal Epidural Ampiyem ve Cerrahi Tedavisi: Olgu Sunumu. Türk Nöroflirürji Dergisi 2011; 21: 60-63.
- 2.Curry WT Jr, Hoh BL, Amin-Hanjani S, Eskandar EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol 2005; 63: 364-371.
- 3.Hernandez JM, Coyle FP, Wright CD, Ballantyne JC. Epidural abscess after epidural anesthesia and continous epidural analgesia in a patient with gastric lymphoma. J Clin Anesth 2003; 15: 48-51.
- 4.Horlocker TT, Wedel DJ. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol 2008; 22: 451-475.
- 5.Grabysa R, Moczulska B. Spinal epidural abscess penetrating into retroperitoneal space in patient with diabetes mellitus type 2: early diagnosis and treatment requirement. Pol Arch Med Wewn 2008; 118: 68-72.
- 6.Lu CH, Chang WN, Lui CC, Lee PY, Chang HW. Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 2002; 104: 306-310.
- 7.Choma T, Burke M, Kim C, Kakarlapudi R. Epidural abscess as a delayed complication of spinal instrumentation in scoliosis surgery: a case of progressive neurologic dysfunction with complete recovery. Spine 2008; 33: 76-80.
- 8.Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006; 355; 2012-2020.
- 9.Löhr M, Reithmeier T, Ernestus RI, Ebel H, Klug N. Spinal epi- dural abscess: prognostic factors and comparison of different sur- gical treatment strategies. Acta Neurochir 2005; 147: 159-166.
- 10.Tang HJ, Lin HJ, Liu YC, Li CM: Spinal epidural abscess -- experience with 46 patients and evaluation of prognostic factors. J Infect 2002; 45: 76-81.