Features of surgical treatment of isolated spinal epidural abscesses and prevention of the development of postlaminectomic syndrome

Spinal epidural abscess is a neurosurgical pathology accompanied by compression of the spinal cord and requiring urgent surgical intervention. The most commonly performed classic extended laminectomy with removal of the abscess of the epidural space. In some cases, post-laminectomy syndrome may develop in the late postoperative period.

THE PURPOSE of the study is to analyze the immediate and long-term outcomes of various methods of surgical treatment of isolated spinal epidural abscesses and to develop a method to reduce the incidence of postlaminectomy syndrome.

MATERIALS AND METHODS. The study was conducted on the basis of the Sverdlovsk Regional Clinical Hospital No 1. 34 patients with primary, isolated spinal epidural abscesses, who were treated in the neurosurgical department from 2005 to 2019, were divided into two groups. The control group underwent classical laminectomy, and in the main group, the operation was performed using the original method of «fenestrated» interhemilaminectomy. / The dynamics of the severity of vertebral pain syndrome was assessed according to the digital pain rating scale, the Karnovsky scale, the Oswestry disability index (ODI), the incidence of postoperative complications, long-term results, the incidence of postlaminectomy syndrome in two comparison groups.

RESULTS. Reducing the volume of the surgical wound and changing the method of drainage when using the proposed method was accompanied by a decrease in the frequency of local infectious complications (40 % and 10.5 %, respectively), the severity of residual vertebrogenic pain syndrome as in the early (3.6 ± 0.6 and 2.5 ±0.5, respectively), and in the late postoperative periods (2.7±0.9 and 1.4±0.7, respectively), as well as the incidence of postlaminectomy syndrome (23.1 % and 6.25 %, respectively) (p<0.05).

CONCLUSION. The introduction of the original method of «fenestrated» interhemilaminectomy allows to reduce the volume of the surgical wound and perform more effective drainage in the postoperative period, which improves the immediate and long-term outcomes of surgical treatment, as well as reducing the incidence of post-laminectomy syndrome.

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