In the vast majority of cases, spinal suppuration occurs at the lumbar level, less often at the thoracic level. Our patient developed suppuration (spondylitis with epidural abscess) at the upper cervical level – at the level of 1-2 cervical vertebrae, where the skull attaches to the spine.
Headache, inability to hold the head, increased body temperature and weakness in the muscles of the right arm. Such complaints arose suddenly. Several times, CT scans of the head and neck were performed, which did not allow finding pathology. MRI revealed an epidural abscess with spinal cord compression at the level of C1-2 vertebrae, more on the right and purulent fusion of the C2 tooth, deformation of the vertebra.
Treatment with antibiotics for 2 weeks not only did not give any results, but even the condition gradually worsened. Puncture of the abscess under X-ray control also did not allow to evacuate the pus – it became clear that there was no pus anymore, but the granulations were pressing on the nerve structures.
The only chance to save the patient was surgery. But “getting” an abscess at such a level is very difficult due to anatomical features. The situation was also complicated by the fact that the purulent process “corroded” the ligaments between the vertebrae, which made it impossible for the patient to hold his head up.
Therefore, the patient underwent a highly complex three-stage operation.
- The first step was to install a tracheostomy – a tube from the trachea to the outside, which made it possible to perform mechanical ventilation during surgery in the mouth.
- The second stage was a posterior stabilization from the occipital bone to the C3 (third cervical) vertebra, which made it possible to stabilize the spine and prevent dangerous displacement of the vertebrae and injury to the cervical spinal cord. Such an injury could cause many complications and even instant death.
- The third stage was the removal of the C2 tooth, which had melted the purulent process, through the mouth, as well as purulent granulations (growths) and decompression of the spinal cord, after which a stabilizing prosthesis was installed.
The result of the operation was satisfactory. Immediately after the operation, the headache disappeared . The next day the patient walked around the hospital. The tracheostomy was also removed the next day. Feeding was done through a tube until the wound in the mouth healed, after which the tube was also removed. The patient was discharged home in a satisfactory condition after 2 weeks.
Significant experience in the treatment of such pathology, highly qualified personnel, an operating room equipped with modern technology at the Ternopil Regional Clinical Psychoneurological Hospital, incredible conditions in the department, high-quality anesthesia care – all this became the key to success in the treatment of such pathology.
Do you think similar operations are performed anywhere else in Ukraine? If you know, please write in the comments.
We are always happy to help you with all the most difficult problems.
The article was prepared by Leontiev O.
Video report at the link
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