Epidural abscess surgery

Suppurative inflammation of the epidural space is more common in suppurative inflammation of the spinal canal. Skin acne is the most important primary infection, and the majority of pathogenic bacteria are Staphylococcus aureus, and bloodline dissemination is the most common. It occurs mostly in the back of the upper thoracic vertebrae, which causes symptoms of spinal cord damage, mostly sharp and serious; if the surgical treatment is timely, most of them can be cured, and misdiagnosis will delay severe disability and even death. Treatment of diseases: epidural abscess, children with epidural abscess, spinal cord compression Indication The clinical diagnosis of epidural abscess is established, or lumbar puncture, paraspinal puncture and pus extraction, or myelography confirmed that spinal cord compression should be treated surgically. A sharp and serious condition should be considered as a neurosurgical emergency. Preoperative preparation 1. Non-urgent patients should start skin preparation before 3 days, and then disinfect and dress before surgery. If you are in an emergency, you should prepare your skin carefully and disinfect it. 2. Prevent the occurrence of hemorrhoids. If it has already occurred, he should be treated properly before surgery. 3. If the patient has urinary tract infection or high fever, it is necessary to control acute infection, and surgery should be performed after the body temperature drops. 4. For high paraplegia, respiratory insufficiency, should pay attention to prevention and control of lung infections, especially for the elderly. 5. Anemia patients should receive a small number of blood transfusions before surgery, and blood preparation during surgery is about 400ml. Surgical procedure 1. Position in the lateral or prone position. 2. Take the lesion as the center for the midline incision. If the abscess has worn the spinal canal and forms a paravertebral abscess, the pus can be seen during the process of revealing the spinous process and the lamina. Otherwise, the epidural can be seen by first biting 1 or 2 lamina in the center of the lesion. Abscess, and then according to the extent of the lesion, the upper and lower ends are enlarged, while the side is revealed, while the pus is removed, and the pulsation occurs in the upper and lower areas of the dura mater. If the lamina and vertebral body of the lesion have suppurative osteomyelitis, the bone is soft and brittle. Care should be taken when removing the muscle from the lamina, and the force is not too strong to prevent damage to the spinal cord. Laminectomy should not damage the articular surface, and the epidural granulation tissue should be gently scraped off, taking care not to damage the dura mater. Try not to leave bone wax or gelatin sponge in the wound to avoid foreign body reaction. Do not cut the dura mater to prevent infection from spreading into the subdural space. 3. In the case where the inflammation does not spread to the muscular layer or the surgery is found to be mainly granulation tissue and the wound is not seriously contaminated, all the incisions can be sutured. Generally, people with severe infections are still safe to place drainage tubes. The drainage tube was removed after 24 to 48 hours. Severe infection, pus extensively spread to the muscle layer, estimated cases of ineffective drainage, can be filled with gauze drainage in the wound, and then removed daily, residual wounds to granulation tissue growth or second-stage suture. complication After the formation of the abscess, compression of the spinal cord can also cause inflammatory thrombosis of the blood vessels, causing blood supply to the spinal cord, which may cause paralysis. Due to the malfunction of the nerve function, part of the body completely or incompletely loses its athletic ability/metaphoric mechanism; it cannot work normally. refers to the decline or disappearance of voluntary movements. Clinically, sputum is divided into functional sputum and organic sputum. The former is caused by psychogenicity, that is, snoring. Organic sputum can be divided into upper motor neuron, lower motor neuron, and myopathy according to the anatomy of the lesion.