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Spinal bacterial (purulent) epiduritis

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Spinal bacterial (purulent) epiduritis

Spinal purulent epiduritis is a collection of pus in the epidural space. The cause of acute purulent spinal epiduritis is the penetration of bacterial infection through the lymphatic pathways (less often hematogenously) from purulent foci (boils, subcutaneous abscesses, panaritiums, phlegmon) into the epidural space.

A possible reason for the formation of purulent spinal epiduritis in women can also be the gynecological manipulation carried out the day before. More often, fibrin (pus) accumulates in the posterior epidural space. If the abscess is limited, we can talk about an epidural abscess, with a diffuse process - about phlegmon. Sometimes the infection spreads to the lining of the brain and even the substance of the brain, causing a meningomyelitis process.

Epidural fatty tissue surrounds the lining of the spinal cord. Infection of the epidural tissue leads to purulent spinal epiduritis.

 

Diagnostics of the spinal bacterial (purulent) epiduritis

Acute purulent spinal epiduritis develops rapidly. There is a general serious condition, chills, the temperature rises to 39-40 °C (102.2-104 °F). Consciousness is usually preserved. Patients are worried about acute radicular pain, pain in the occiput and spine, there are both sensory and motor disorders of the radicular nature.

If spinal epiduritis does not spread to the spinal cord and there are no symptoms of its compression, then the patient will not have conduction disorders. When the spinal cord is compressed and myelitis occurs, gross paresis, paralysis, dysfunction of the pelvic organs, trophic disorders (bedsores), and urosepsis appear.

With lumbar puncture, undoubted evidence of epiduritis is the receipt of pus from the epidural space.

A triad was identified in the diagnosis of spinal epiduritis: the presence of a purulent or infectious focus, radicular syndrome, spinal cord compression syndrome. Lumbar puncture (LP) is of great diagnostic value when epiduritis is suspected. Undoubted evidence of epiduritis is the receipt of pus from the epidural space after lumbar puncture.

Epidural spinal abscess on MRI.

In the absence of compression of the spinal cord with spinal epiduritis, pleocytosis can be found in the cerebrospinal fluid, and with compression of the cerebrospinal fluid, protein-cell dissociation.

 

Treatment of spinal bacterial (purulent) epiduritis

In the treatment of spinal epiduritis, intensive use of broad-spectrum antibiotics and sulfa drugs is required. In the absence of improvement from conservative therapy in the treatment of epiduritis, the patient needs surgery.

The prognosis for the treatment of spinal epiduritis, which does not extend to the substance of the brain and the spine, is currently favorable.