Spinal purulent epidurit( pachymeningitis external) - Causes, symptoms and treatment. MF.
The cause of purulent spinal epiduritis is the spread of infection through the blood vessels and lymphatic pathways from the inflammatory foci to the epidural space( most often staphylococcus)., less often with injuries of the spine, iatrogenic character is possible in the course of lumbar puncture, peridural anesthesia. Predisposing factors are: trauma of the spine with the formation of hematomas in epidural fiber and bone fragments, colds, hypothermia.
Symptoms of purulent spinal epidurit
• Intoxication syndrome( high fever, general severe condition)
• Intensive radicular pain in the innervation zone of the corresponding spinal nerves
• Local soreness that increases with palpation and percussion
• Meningeal syndrome( cmMeningitis bacterial)
• Signs of increasing compression of the spinal cord( paralysis or paresis of the limbs, impaired sensitivity below the level of compression and pelvic functionO bodies).
Spinal purulent epiduritis develops sharply, with high temperature, leukocytosis in the blood( up to 16 000-20 000), high ROE.In chronic course, the onset is gradual. Later there are radicular pains, sometimes very intense, as well as compression of the spinal cord. There is a decrease in sensitivity by the radicular type, and when the spinal cord is compressed, according to the conductor type;as a rule, there are paresis and paralysis of the extremities. Paresis can be lethargic( with a significant seizure of roots) and spastic( with a sharp compression of the spinal cord).This is accompanied by pelvic disorders.
Diagnosis of purulent spinal epidurit
Diagnosis of purulent spinal epiduritis is based on the presence of a purulent focus, fever, acute radicular syndrome, symptoms of compression of the spinal cord. Of decisive importance in differentiation with myelitis are the data of myelography, which reveal the blockade of the subarachnoid space during epiduritis.
• Laboratory studies: confirm the presence of inflammation( neutrophilia, left leukocyte shift, increase in ESR)
• Obtaining pus with puncture of the epidural space at the level of lesion( lumbar puncture)
Lumbar puncture produced below the localization of the pathological process shows an increase in protein content, sometimesxanthohromia and pleocytosis( up to 50 cells)
• Lumbar puncture discovers some degree of blockade of the subarachnoid space( disruption of the circulation of cerebrospinal fluid)and an increase in protein content in CSF
• MRI and CT are the most informative.
Differential diagnosis of purulent spinal epidurit
• Other diseases that cause compression of the spinal cord( tumors, trauma)
• Transverse myelitis.
Treatment of purulent spinal epidurit
Diagnosis of acute purulent epiduritis requires urgent surgery - extensive laminectomy( opening of the vertebral canal by removing arches of the vertebrae), removal of the abscess, and subsequent drainage of the epidural space. After the operation - vigorous and massive therapy with broad-spectrum antibiotics and restorative therapy.
With timely intervention( at stage 1 of the disease) and absence of dissemination of abscesses along the epidural space, the prognosis is quite favorable, in the later stages, as a rule, unfavorable.
Complications of purulent spinal epidurit
• Formation of a spinal epidural abscess or phlegmon
• Spreading of inflammation on the spinal cord membranes( meningomyelitis process)
• Development of purulent meningitis after lumbar puncture in the lumbosacral location of epidurit( introduction of infection into the subarachnoid space).