Spinal Cord And Root Compression

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SPINAL INFECTION

- very rare in Britain)

(parasitic hyatid disease

Bacterial Acute abscess, e.g. staphylococcus Low grade pyogenic infection, e.g. BruceL Granuloma - TB, sy

EPIDURAL

(syn, extradural^

(syn, extradural^

^ intradural (rare)

(subdural or intramedullary)

Cytomegalovirus Fungal, e.g. Candida Parasitic, e.g. Cystocercosis

^ intradural (rare)

(subdural or intramedullary)

meningitis) Tuberculoma

Pyogenic abscess formation

ACUTE EPIDURAL ABSCESS

Tend to occur in debilitated patients - diabetes, malignancy, liver or renal failure, intravenous drug abuse and alcoholism.

Organism: Staphylococcus aureus is the most common agent (90% of cases)

Spread: Haematogenous, e.g. from a boil or furuncle, or direct from vertebral osteomyelitis.

Site: Usually thoracic, but may affect any level and be extensive. Cord damage occurs either from direct compression or secondary to a thrombophlebitis and venous infarction.

Clinical features: Develops over several days mimicking a rapidly progressive extradural tumour or haematoma with bilateral leg weakness, a sensory level and urinary retention, but distinguishing features are:

- very severe pain and tenderness over the involved site.

- toxaemia: pyrexia, malaise, increased pulse rate.

- rigidity of neck and spinal column, with marked resistance to flexion. As the abscess extends upwards, the sensory level may rise.

Investigations: Straight X-ray may or may not show an associated osteitis. An MRI or myelogram confirms the site of the extradural lesion. CSF examination, if performed shows an increased white cell count, usually polymorphonuclear, but may be normal.

A leucocytosis is usually present in the peripheral blood and the ESR raised. Blood cultures are usually positive.

Management: Urgent decompressive laminectomy and abscess drainage combined with intravenous antibiotic therapy over some weeks provide the best chance of recovery of function.

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