探讨硬脊膜外脓肿(SEA)的临床诊断学特征。

回顾分析1例SEA不伴发热患者的临床资料，并复习文献。

患者为老年男性，于2016年6月22日22时因腰背部疼痛及双下肢活动受限在济宁医学院附属医院脊柱外科就诊。患者2型糖尿病病史3余年，未曾服药控制血糖。入院时体温36.8℃，血糖8.2 mmol/L，白细胞计数10.80×10⁹/L，C-反应蛋白82 mg/L和中性粒细胞百分比83.60%。术前磁共振(MRI)平扫结果：T_7-11节段椎管内脊髓后方异常高信号；急诊行"椎管减压术"，术中见椎管内白色黏稠脓液，并取脓液送细菌培养；术后细菌培养结果为金黄色葡萄球菌，术后19 d MRI平扫结果：脊髓压迫已解除，脊髓后未见异常信号；术后10个月随访，患者双下肢活动正常。

SEA是一种少见病，其早期诊断具有一定困难，其中SEA不伴发热的诊断更为困难，需要结合临床医生经验、患者临床表现、实验室检查、影像学检查等，方可做出正确诊断。糖尿病患者是SEA的高发人群，当该类人群出现腰背痛和炎症指标升高时，尽管没有发热，也应怀疑SEA的发生，并进一步行MRI明确诊断。

To explore the diagnosis features of spinal epidural abscess (SEA).

The clinical data of 1 case of SEA without fever was analyzed retrospectively.Literatures were reviewed and features of clinical diagnosis of SEA were summarized.

The patient was an old man, and was admitted to department of spine surgery of Affiliated Hospital of Jining Medical University for low back pain and paralysis of lower limbs.He had a history of diabetes mellitus for more than 3 years without taking medicine to control his blood sugar.On admission, his body temperature was 36.8℃, blood sugar 8.2 mmol/L, initial white-cell count 10.80×10⁹/L (83.60% neutrophils), and serum C-reactive protein 82 mg/L.MRI revealed abnormal high signal in T_7-11 segment of intraspinal epidural space at admission.Decompressive laminectomy was performed urgently.During the operation, the white viscous pus in the spinal canal was observed and the pus was taken for bacterial culture.The result of bacterial culture was Staphylococcus aureus.Postoperative MRI scan which performed on the nineteenth day after surgery revealed the spine has been decompressed successfully.After 10 months follow-up, the lower limbs recovered.

Clinically, SEA is an uncommon disorder, and the early diagnosis of SEA is difficult, especially SEA without fever.The accurate diagnosis needs a combination of clinician experience, clinical manifestation in patients, laboratory examination and imaging assays.Patients with diabetes mellitus are the highest risk subgroup of SEA.When the diabetic patients with low back pain and the increase of inflammatory markers, spinal epidural abscess should be considered, although patient′s body temperature is normal.And further, MRI should be carried out to clarify the diagnosis.