ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Spinal abscess is an inflammatory disease where pus is formed and collected in the spinal canal outside the dura. Risk factors include diabetes, alcohol and drug abuse, kidney failure, operations and lumbar puncture etc. The abcess can cause compression of spinal cord and nerve roots.
CAUSE OF SYMPTOMS
Acute compression of the spinal cord and/or nerve roots
Bacterial inflammation of the vertebrae and intervertebral discs
SYMPTOMS AND SIGNS
Total/partial paralysis and numbness from the site of the spinal cord damage downwoads
Severe back pain above the inflammation
Pain in limbs
THE DIAGNOSIS IS BASED ON Medical history Clinical exam
Blood tests Blood cultures Magnetic resonance imaging (MRI)
Combined treatment: emergency surgery and antibiotics is the preferred treatment for the spinal abscess, removing existing pus (which is tested for microorganisms to select the most appropriate antibiotic) and removing pressure from the spinal cord and nerve roots. Antibiotic therapy should start after obtaining pus for microbiological investigation.
Non-surgical treatment may include Antibiotics
WHEN SHOULD AN OPERATION BE PERFORMED?
In most cases emergency surgery is required
WHAT IS THE GOAL OF SURGERY?
Obtaining material for histological examination
To release the compressed nerve roots and/or spinal cord
To preserve the protective function of the spine
HOW IS SURGERY PERFORMED?
Abscess fenestration via a posterior approach.
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Bleeding in the spinal canal Tumor of the spine Vertebral fractures Spondylodiscitis