Treatment of Spinal Cord Empyema

Spinal cord empyema is a severe purulent inflammation that spreads to several segments. Unlike an abscess, the purulent process is not limited to the capsule, and therefore it can affect a significant part of the spinal cord. The disease is life-threatening. It requires intensive care, antibiotics, and operation.

Content

1. Causes of spinal cord empyema
2. Symptoms
3. Diagnostics
4. Treatment
5. Why it is worth undergoing treatment abroad

Causes of spinal cord empyema

The cause of inflammation is the spread of bacteria from other foci of infection in the body. It can be inflammation of the ear, nasal sinuses, meninges (meningitis). Sometimes the infection is carried directly into the space near the spinal cord: during an injury, operation, or lumbar puncture.

The cause may be suppuration of the spinal cord hematoma, osteomyelitis, the spread of infection through the blood from any internal organs, for example, in case of pneumonia, pyelonephritis, cystitis, etc.

The causative agent is usually staphylococci. Less often, this can be streptococci, meningococci, anaerobes, fungal microflora.

Symptoms 

Depending on the location of the spinal cord empyema, the first symptom is back or neck pain. Then radicular syndrome appears. There is growing weakness in the legs or arms, loss of pain and temperature sensitivity, and pelvic disorders.

The thoracic and lumbar spinal cord is more often affected. But there are many other localizations, including empyema of the spinal cord of the cervical spine. With the development of the disease, the spinal cord and the roots of the spinal nerves are compressed. A person can also suffer from impaired circulation of cerebrospinal fluid and destruction of the spinal cord tissue with the development of irreversible neurological deficit.

The disease can develop very quickly and sometimes progress gradually over several weeks. When conducting a diagnostic examination of the patient, the doctor may detect redness in the area of inflammation, and on palpation, severe pain is felt. Systemic symptoms appear: fever, headache, malaise.

For purulent inflammation of the spinal cord, a staged course is characteristic. There are four clinical stages of the disease:

• Stage 1 – back pain;
• Stage 2 – radicular pain. 
• Sage 3 – muscle and sphincter weakness, sensory disorders. 
• Stage 4 – paralysis.

Diagnostics 

Instrumental diagnostics involve the use of CT and MRI. They allow for imaging the spinal cord, identifying an inflammation focus, determining its size and location.

It is important to identify the infectious agent in order to conduct targeted therapy. For this purpose, a bacteriological study is carried out. Blood culture is usually done, and cerebrospinal fluid culture is also possible. To obtain it, a lumbar puncture is used. If its performance is impossible, the puncture is made not in the lumbar region, but under the occipital bone.

Treatment 

The treatment can be either conservative or surgical:

Goals of treatment: 

• Suppression of infection.
• Elimination of a purulent focus.
• Elimination of spinal cord compression. 
• Prevention of complications, such as heart attack (ischemic stroke) of the spinal cord due to vascular compression and thrombosis, inflammation of the brain and its meninges (meningitis, encephalitis).

Spinal cord empyema is a serious, potentially fatal disease. Those patients who survive often develop neurological deficits. Therefore, it is worth undergoing treatment as early as possible.

Immediately after the patient is admitted to the hospital, antibiotic therapy is started. Typically, doctors use at least two broad spectrum drugs that cover most infectious agents. Medicines are administered intravenously. After receiving the results of a bacteriological study with an assessment of the sensitivity of the isolated flora to antibiotics, doctors can adjust antibiotic therapy.

The operation is performed as early as possible. The main intervention is decompressive laminectomy. The doctor removes the arch of several vertebrae. He opens and drains a purulent focus. It is possible to implant a flow-washing drainage. Periodically, the wound is washed with antiseptics to suppress microflora.

Why it is worth undergoing treatment abroad 

For neurosurgical operations, many patients prefer to travel abroad to undergo treatment in one of the best clinics in the world. Spinal cord operations are complex and not always safe. It is important not only to sanitize the purulent focus, to ensure its washing and suppression of microflora, but also to make the surgical intervention as sparing as possible, so as not to cause neurological deficit, and not to disturb the stability of the spine.

Foreign specialists cope with this task. There are several reasons why you should undergo treatment at one of the clinics abroad:

• State-of-the-art equipment. 
• The world's best spinal surgeons. 
• Individual choice of antibiotics based on the sensitivity of the isolated microflora.
• Minimal spinal trauma rate during surgery.
• Preservation or restoration of the stability of the spinal column.
• Low risk of complications.
• Full rehabilitation.

After timely treatment, the spinal cord functions can be completely restored. If a neurological deficit develops, doctors try to minimize it. After recovering abroad, one can undergo rehabilitation. Full recovery will restore limb mobility, tissue sensitivity, and regain control over bowel movements, and urination.

To undergo spinal cord empyema treatment abroad, please use the services of Booking Health. We will help you find the most suitable empyema clinics and take care of the organization of your trip. On the Booking Health portal, you can compare prices and book a medical care program at a beneficial price. Due to the lack of additional coefficients for foreign patients, the cost of treatment for you will be lower.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko