A spinal abscess can have a variety of causes. If he is not treated promptly with surgery and antibiotics, the patient can become paraplegic or even die of blood poisoning. The causes are often infections that arise elsewhere in the body and spread through the bloodstream.
What is a spinal abscess?
A spinal abscess is a collection of pus in the spinal canal. It occurs with a probability of 1 in 10,000 hospital admissions (and rising). Spinal abscesses can be located outside the dura mater of the spinal cord (epidural) and outside or inside the spinal cord (extramedullary, intramedullary). About half of all statistically proven spinal abscesses are located epidurally in the area of the thoracic spine. For what does the abbreviation hm stand for, please visit usvsukenglish.com.
Most patients are between 40 and 75 years old. The disease usually occurs in combination with spondylodiscitis. It is an infection of the vertebral bones and the associated intervertebral disc. In the advanced stage, the spinal abscess is often encased in a sac of pus. Its expansion in the spinal canal is associated with pain. If the abscess is not treated, it will quickly cover an entire section of the spine.
Patients with a weakened immune system ( those infected with HIV ), with diabetes mellitus, renal insufficiency and the chronically ill have an increased risk of developing a spinal abscess.
Spinal abscesses can have a variety of causes. Often there are sources of infection in other parts of the body that spread their pathogens via the bloodstream into the spinal canal: furuncles, urinary tract, respiratory tract and tooth infections. Sometimes the pathogens also spread from decubitus ulcers (they develop from prolonged bed sores), lumbar abscesses, hand and foot infections and open injuries.
Operations on the spine (intervertebral disc surgery), placement of epidural catheters, local anesthesia of the lower half of the body to perform a surgical procedure (epidural anesthesia) and lumbar punctures can also lead to the occurrence of spinal abscesses. The probability of contracting spinal canal suppuration through conservative pain therapy for sciatica or lumbago with corticosteroids is between 1:1,000 and 1:100,000.
Incorrect placement of a catheter – albeit a very rare occurrence – insufficient sterility of the catheter and a catheter that has been in place for too long can also lead to such an accumulation of pus. The same applies to inflammation of vertebral bodies ( osteomyelitis ). Sometimes even tattoos and treatment with acupuncture needles are risk factors. Most spinal abscesses are caused by Staphylococcus aureus infection.
Less commonly, E. coli, anaerobic and aerobic streptococci, salmonella, Pseudomonas aeruginosa, tubercle bacteria, fungi, and parasites cause a spinal abscess. The high number of methicillin-resistant Staphylococcus aureus pathogens that are involved in the development of the infection is of recent concern. In about ten percent of cases, a mixed infection is the cause.
Symptoms, Ailments & Signs
The first symptoms of the abscess are high fever and exhaustion. Patients have severe tenderness at the level of the abscess. In advanced stages, spinal cord damage manifests itself in the form of neurological deficits and motor deficits. If they are not treated within a day, paraplegia with impaired bladder and bowel movements is the inevitable result.
Diagnosis & course of disease
The disease is usually detected using imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). The MRI shows the exact extent of the collection of pus. In addition, cerebrospinal fluid is taken from the patient. If the analysis shows an increased proportion of proteins and white blood cells, there is a spinal abscess.
The finding is supported by an increased blood sedimentation rate. The course of the spinal abscess is usually subacute and acute because of the rapid spread of the bacteria. Chronic courses occur when it was caused by an infection localized in its immediate vicinity (spondylodiscitis, osteomyelitis ). In acute cases, action must be taken quickly to prevent complete paralysis.
In the worst case, this disease can lead to blood poisoning. The person affected can die if the poisoning is not treated. However, without treatment, paraplegia can also occur, which is usually not reversible and cannot be treated.
Those affected primarily suffer from severe exhaustion and also from fever. It comes to pressure pain and thus to severe limitations in movement. Due to these limitations, many patients also suffer from psychological problems or depression. Furthermore, neurological deficits or paralysis occur.
If left untreated, most cases result in paraplegia. The patient is then dependent on a wheelchair and usually also on the help of other people in his everyday life. The treatment depends very much on the exact cause and the symptoms. However, if treatment is started early, most symptoms can be alleviated and complications avoided. Furthermore, those affected are also dependent on rehabilitation measures to restore full movement.
When should you go to the doctor?
This disease always requires a visit to a doctor. As a rule, self-healing is not possible, so that the affected person is dependent on a medical examination and treatment in any case. Only proper treatment can prevent further ailments and compilations. In the worst case, the person concerned dies of blood poisoning. A doctor should be consulted if the person affected suffers from a strong fever and severe exhaustion.
In most cases, the abscess continues to cause severe pain, which occurs for no particular reason and, above all, is permanent. Paraplegia can also indicate this disease and should always be examined and treated by a doctor. As a rule, this disease can be recognized and diagnosed by a general practitioner. It cannot be universally predicted whether complete healing is possible.
Treatment & Therapy
If the patient is in an advanced stage of the disease or if he has blood poisoning, he must be operated on as soon as possible. In laminectomy, accumulated pus and granulation tissue are removed from behind. If the abscess is larger, drains must be placed at various points in the spinal canal.
The fluid taken is analyzed in order to be able to prescribe the appropriate antibiotics later. The drainage is usually done as a flush-suction drainage: The cavity in which the pus is located is additionally flushed out later. If the cerebrospinal fluid puncture shows, for example, that the abscess was caused by meningitis – the fluid removed is then yellowish-cloudy – it must also be treated. The same applies to the other primary infections that lead to the occurrence of a spinal abscess.
The combination therapy with antibiotics takes place intravenously in the first few days and in the following weeks by administering tablets. Patients who do not yet show any neurological deficits are sometimes only given antibiotics. If the growth of the abscess cannot be stopped, an operation is necessary. If the affected person is operated on in good time, he has a good chance of recovery if the primary infection is also recognized and treated as quickly as possible and there are no complications in the subsequent period.
The prognosis is less good for patients who also have several chronic diseases. The medical aftercare includes regular laboratory tests, radiological checks and a physiotherapeutic rehabilitation measure.
As a preventive measure, patients from risk groups in particular are recommended to have infections of the skin, teeth and respiratory tract treated immediately by a doctor or to prevent them in advance (if possible).
The spinal abscess requires surgical intervention. In the follow-up care, the often fundamentally existing impairments of the patient must be taken into account. In addition to the operation, antibiotics were necessary in the acute therapy. The affected person’s intestines may have been damaged by taking antibiotics, since the intestinal bacteria are also attacked by the antibiotics.
A build-up of the intestinal flora after taking the antibiotics is essential here. In some cases, such measures are already started during the antibiotic treatment, but this aspect should not be left unconsidered at the latest directly in the aftercare. The surgical wound must be checked to ensure that no inflammation has developed or that any bacteria from the abscess itself have remained in the body. The aftercare is usually accompanied by a specialist, an orthopaedist, surgeon or neurosurgeon.
Many patients who experience a spinal abscess have a weakened immune system, such as diabetics or patients with kidney disease. It is also important in the follow-up care to rule out thrombosis and the associated pulmonary embolism as a late consequence. This complication can arise as a result of symptoms of paralysis in the patient and must therefore be closely monitored.
Depending on the effects of the spinal abscess, long-term consequences for the patient cannot be ruled out. Specialist care is required here.
You can do that yourself
Self-help options are insufficient to heal a spinal abscess. Therefore, at the first health irregularities, cooperation with a doctor should be sought. When infections develop, life-threatening developments can occur. Therefore, it is necessary to seek medical care. A good relationship of trust with the doctor treating you should be established, as this is conducive to the further course.
Regular preventive check-ups are advisable so that the first irregularities can be reacted to accordingly. Everyone affected can take advantage of a balanced diet, sufficient exercise and the avoidance of harmful substances for themselves and to optimize their health. A healthy lifestyle contributes significantly to a positive course of the disease and to the alleviation of existing symptoms.
If physiotherapeutic measures are initiated, the exercise units learned can also be used outside of therapy. Motion sequences are to be optimized and overloading of the body should be avoided as a matter of principle. In the case of sporting activities, care must be taken to ensure that these are adapted to the requirements of the organism and that overexertion is avoided. A balanced leisure activity is also helpful. With a positive attitude towards life, humor and a stable social environment, the challenge of the disease can be mastered much better.