Spinal purulent epidurit ( pachymeningitis outer ) - Causes, Symptoms and Treatment .MF .
purulent spinal epidurit (pachymeningitis outer) - rapidly developing inflammation of the spinal canal epidural fat with formation of pus in the epidural space that occurs secondary to the presence of foci of infection in the body (abscesses, boils, osteomyelitis).Often accompanied by spinal meningitis.
reason purulent spinal epidurita - the spread of infection through the blood vessels and lymphatic vessels of inflammatory lesions in the epidural space (usually staphylococcus)., Rarely with spinal injuries, possible iatrogenic character during lumbar puncture, epidural anesthesia.Contributing factors are: spinal injury with the formation of hematomas in the epidural tissue and bone fragments, colds, hypothermia.
Symptoms of suppurative spinal epidurita
• Intoxication syndrome (high fever, general heavy state)
• Intense radicular pain in the innervation area of the corresponding spinal nerves
• Local pain, aggravated by palpation (palpation) and percussion (rapping)
• meningeal syndrome(see
• Signs of increasing compression of the spinal cord (paralysis or paresis of the extremities, sensory loss below the level of compression and pelvic organs).
Spinal purulent epidurit develops acutely, with fever, leukocytosis in the blood (up to 16 000-20 000), a high ROE.In chronic course start gradually.In the future, there are radicular pain, sometimes very intense, and spinal cord compression.Marked decrease in sensitivity of radicular type, while compression of the spinal cord - on conduction type;usually occur paresis and paralysis of the limbs.Paresis can be sluggish (with a considerable seizure of roots) and spastic (with a sharp compression of the spinal cord).This was accompanied by pelvic disorders.
Diagnostics purulent spinal epidurita
Diagnostics purulent spinal epidurita based on the presence of purulent focus, fever, acute radicular syndrome, the symptoms of spinal cord compression.Of decisive importance in the differentiation with myelitis have myelography data exhibiting at epidurit blockade of subarachnoid space.
• Laboratory research: confirm the presence of inflammation (neytrofilёz shift leukocyte left, increased erythrocyte sedimentation rate)
• Getting pus puncture the epidural space at the level of injury (lumbar puncture)
Lumbar puncture produced below the localization of the pathological process, detects the increase in protein content,sometimes xanthosis and pleocytosis (50 cells)
• Lumbar puncture reveals a certain degree of blockade of subarachnoid space (violation of the circulation of cerebrospinal fluid) and increase the protein content in the CSF
• MRI and CT scans are most useful.
Differential diagnosis of purulent spinal epidurita
• Other diseases causing spinal cord compression (tumor, trauma)
• Transverse myelitis.
Treatment of suppurative spinal epidurita
Diagnosis of acute purulent epidurita requires urgent surgery - wide laminectomy (opening of the spinal canal by removal of the vertebral arches), the removal of an abscess, followed by drainage of the epidural space.After the operation - an energetic and massive therapy broad-spectrum antibiotics and restorative therapy.
forecast is quite favorable, in the later stages, usually unfavorable With timely intervention (1 stage of the disease) and the lack of dissemination of ulcers on the epidural space.
Complications of suppurative spinal epidurita
• Education spinal epidural abscess or cellulitis
• Spread of inflammation in the spinal cord (meningomielitichesky process)
• Development of purulent meningitis after lumbar puncture with lumbosacral localization epidurita (infection in the subarachnoid space).