Epidural (epiduritis; synonym: spinal epidural abscess, outdoor purulent pachymeningitis, purulent peripapillary) - acute or chronic inflammatory process in the epidural space and on the outer surface of the Dura mater of the spinal cord.
Etiology. Epidura - secondary disease. The most frequent reasons are: 1) TB and osteomyelitis processes in the spine; 2) purulent or infectious foci in the body, where the infection is logged hematogenous or lymphogenous by; 3) immediate incursion into the epidural space puncciah (in rare individual cases).
Pathological anatomy. During acute epiduritis find pus in the back of the epidural space of the spinal cord; sometimes inflammatory exudate can be purulent-hemorrhagic. In chronic forms of epiduritis find hyperplastic blend, consisting of a scar or Volokolamskoe granulation tissue. The process may be diffuse, spilled or limited - in the form of individual (single or multiple) foci of various sizes.
The clinical picture. Acute epidural begins sharp radicular pain on the back of high septic temperature and meningeal phenomena. From the level of the affected segment of pain iradionet the nerves of the body and extremities, sharply increasing in movement, coughing, sneezing, defecation and during breathing. After a few hours, and in the first 1-2 days of the disease to the pain attached increasing weakness in the limbs (mostly in the legs) with partial or full dysfunction of pelvic organs (syndrome is the compression of the spinal cord). Depending on the localization process paralysis (paresis) strike or all four limbs (cervical localization) or lower (dorso-lumbar localization); the latter is the most frequent. Along with palsy (paralysis) are conductive disorders of sensitivity down from compression of the source.
The transition of acute purulent epiduritis in chronic characterized by stability and sometimes by a weakening of the compression syndrome: a decrease radicular pain, relative restoration of functions of pelvic organs and movements in the affected limb, lower temperature up to subfebrile. The course of chronic epiduritis characterized by a shift of the phase of exacerbation and attenuation process.
The diagnosis. Recognition of spinal epiduritis proposed (V. Kuimov) the following triad: acute radicular pain on the back of high temperature and meningeal phenomena; syndrome of progressive compression of the spinal cord - sharp compression syndrome; the presence of purulent or infectious focus in the body.
Diagnosis of acute purulent epiduritis not present great difficulties. Chronic epiduritis found either on operations on other lesions of the spinal cord or on the partition.
Forecast for life and for recovery in acute purulent epiduritis is defined by four points: 1) early diagnosis; 2) the etiology of the process; 3) prevalence process clinico epidural space; 4) timely surgical treatment.
Treatment of acute purulent and chronic epiduritis operational with the subsequent use of antibiotics. Early surgical intervention gives a good therapeutic effect.