Subduralny a spinal cord abscess is accumulation of pus in subduralna space that causes compression of the spinal canal and the appearance of neurological symptoms of varying severity.
Typically, this pathology develops in the area of thoracic or lumbar spine. The main reason is the presence of foci of infection. And often it is not in the spine, but at some distance from him. It could be endocarditis, furuncle, abscess on the gums.
The abscess may be near the spine and then the most common reason will be osteomyelitis, decubitus ulcers, and other pus formations not only on the skin, but also on the internal organs.
Often the cause of inflammation in the spine becomes infection in the bladder. Another reason operations or diagnostic procedures on spinal cord. But most of the reasons still remains unknown and the disease is called idiopathic.
Among the pathogens in the first place mention should be made of Golden staph and E. coli, and anaerobic microbes. Rarely there is the tubercle Bacillus.
Symptoms
The disease begins with acute back pain in the area of development of inflammation. The pain occurs at first sporadically, and then becomes regular. Pain appear not only during movements, but when palpation or percussion of the affected area.
Often the body temperature rises. Can present compression of spinal cord or cauda equina, causing paresis of the lower extremities. This symptom appears for several hours, and only in extreme cases – days.
Low-grade fever and General symptoms of malaise and lack of appetite progressing until then, until the sepsis and the temperature reaches a critical level. There are not only paresis and paralysis of the lower extremities, and disruption of bowel and bladder.
The growth of the abscess is a violation of blood supply of the spinal cord. It becomes the cause of acute ischemia, and then infarction. The result is persistent neurologic changes that never pass and are not amenable to treatment.
Diagnosis
The diagnosis is based on complaints of the patient, the presence of an abscess in the body as well as the analysis. The ideal option should be considered as MRT, as only such study will allow to pinpoint where it came lose and how badly damaged the spinal cord.
Puncture in this case is contraindicated, since it can cause klineline abscess, from which the spinal nerve compression will only intensify.
With regard to radiography, a role in the diagnosis, it does not play as can not see soft tissue and nerve fibers. It can help to trace the bone structure, but this disease all the vertebrae are completely healthy.
All patients necessarily performed a blood test and urine. The blood test revealed an elevated leukocyte count and erythrocyte sedimentation rate. A urine test will reveal inflammation of the urinary bladder at an early stage.
How to get rid of
The treatment is carried out only in a hospital, as may be required resuscitation. We must try to find the source of infection and to conduct the remediation. Also, the antibiotics necessary to do the sensitivity analysis and the type of germs that caused the inflammation. Only then can be assigned to antibiotic therapy.
Antibiotics are mostly of two or three groups at a time. Most often in the first few days they are administered intravenously in a glucose solution, and then move on intramuscular injection.
Always perform drainage of the abscess, which has caused compression of the spinal cord. That’s the only way to get rid of this inflammatory focus. Can be used the introduction of the antibiotic in this place, and hormone preparations to relieve inflammation.
Drainage is carried out in the form of decompensated laminectomy and removal of content. Recently, even there is no incision, a drainage tube is introduced under the control of CT or MRI that has become much easier and simpler.
The forecast at correct and timely treatment, as well as the minimum encountered neurological manifestations is always good. If treatment is started late, the antibiotic is selected correctly and there are neurological manifestations, then there may come a death.
