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Khirurgii

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Year 2019 Vol. 27 No 1

NEUROSURGERY

K.M. KUBRAKOV, V.I. PETUKHOV, A.V. KORNILOV

VACUUM THERAPY APPLICATION IN SURGICAL TREATMENT OF SPINAL EPIDURAL ABSCESSES

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To improve the surgical treatment results in patients with spinal epidural abscesses.
Methods. Surgical removal of spinal epidural abscesses, including interlaminectomy using a vacuum-draining system, was performed in 5 patients. The median age of patients was 58 [52; 64] years, 3 patients were males, 2 -females. On admission, the neurological status was studied, laboratory, bacteriological and instrumental methods of examination (computed and magnetic resonance imaging, bone scintigraphy) were carried out. The intensity of the pain syndrome was determined by the visual analogue scale (VAS). Sepsis was confirmed in 3 patients.
Results. A positive clinical outcome was achieved in 5 patients. The severity of pain before treatment and 2-3 days after surgery significantly decreased from 8.0 [8.0; 9.0] points to 5.0 [4.0; 5.0] on the VAS scale. On discharge, pain in 4 patients had almost completely regressed, but 1 patient still had a mild pain (4 points on the VAS scale) in the postoperative wound area. All patients had a regression of neurological deficit – an increase in the strength and volume of active movements in the lower limbs up to 4 points, the normalization of the functions of the pelvic organs. There was no postoperative kyphotic spinal deformity in any patient. Recurrence of inflammatory process, requiring re-operations was not observed. Despite the positive neurological symptoms, regression of pain and an increase in the volume of active movements in the analyzed group, there was one death due to the extremely severe septic condition of the patient which had been already on admission.
Conclusions. The developed method of the spinal epidural abscesses surgical treatment, including interlaminectomy throughout the purulent focus and the installation of a vacuum-draining system, provides adequate sanitizing effect, rapid elimination of edema of the adjacent soft tissues, neural structures and high-quality tissue repair.

Keywords: spinal epidural abscess, vacuum therapy, drainage, interlaminectomy, lumbar pain, postoperative period
p. 59-65 of the original issue
References
  1. Dekonenko EP, Kupriianova LV, Tropikhin IM, Golovatenko-Abramov KV. Spinal’nyi epidural’nyi abstsess – klinicheskie osobennosti i slozhnosti differentsial’noi diagnostiki. Al’m Klin Meditsiny. 2001;(4):55-57. https://cyberleninka.ru/article/n/spinalnyy-epiduralnyy-abstsess-klinicheskie-osobennosti-i-slozhnosti-differentsialnoy-diagnostiki (in Russ.)
  2. Fadeev BP, Karabaev ISh. Diagnostika i lechenie gnoinykh spinal‘nykh epiduritov. Sankt-Petersburg, RF: VMedA, 2004. 25 p. (in Russ.)
  3. Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol. 2014 Sep;87(1041):20140011. doi: 10.1259/bjr.20140011
  4. Firsov SA, Snopko SV, Kornilova IV, Tumorin LS. Purulent spinal epiduritis: a latent threat. Tikhookean Med Zhurn. 2015;(4):92-94. https://tmj-vgmu.ru/index.php/ru/2015-god/4-62/1023-gnojnye-spinalnye-epidurity-skrytaya-ugroza (in Russ.)
  5. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000 Dec;23(4):175-204; discussion 205. doi: 10.1007/PL00011955
  6. Manoso MW, Cizik AM, Bransford RJ, Bellabarba C, Chapman J, Lee MJ. Medicaid status is associated with higher surgical site infection rates after spine surgery. Spine (Phila Pa 1976). 2014 Sep 15;39(20):1707-13. doi: 10.1097/BRS.0000000000000496
  7. Rigamonti D, Liem L, Sampath P, Knoller N, Namaguchi Y, Schreibman DL, Sloan MA, Wolf A, Zeidman S. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999 Aug;52(2):189-97. doi: 10.1016/S0090-3019(99)00055-5
  8. Dandy WE. Abscesses and inflammatory tumors in spinal epidural space (so-called pachymeningitis externa). Arch Surg. 1926;13(4):477-94. doi: 10.1001/archsurg.1926.01130100021002
  9. Nuttall J, Evaniew N, Thornley P, Griffin A, Deheshi B, O’Shea T, Wunder J, Ferguson P, Randall RL, Turcotte R, Schneider P, McKay P, Bhandari M, Ghert M. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res. 2016 Aug;5(8):347-52. doi: 10.1302/2046-3758.58.BJR-2016-0036.R1
  10. Kolesov SV. Surgery for severe postlaminectomy spinal deformities. Khirurgiia Pozvonochnika. 2006;(2):029-032. doi: 10.14531/ss2006.2.29-32 (in Russ.)
  11. Goncharov MY, Sacovich VP, Danilov EP, Cherepanov AV, Volkov IV, Levchik EY. Immediate results of treatment for pyogenic nonspecific spine desease. Khirurgiia Pozvonochnika. 2005;(2):070-072. https://www.spinesurgery.ru/jour/article/view/1138/965 (in Russ.)
  12. Gain JuM, Bordakov PV, Bordakov VN, Shakhrai SV, Gain MJu, Elin IA. Vacuum-therapy at the surgical infection of soft tissues. Voen Meditsina. 2016;(4)):64-72. https://www.mil.by/ru/smi/medicine_magazine/922 (in Russ.)
  13. Obolenskii VN, Nikitin VG, Semenistyi AIu, i dr. Ispol‘zovanie printsipa lokal‘nogo otritsatel‘nogo davleniia v lechenii ran i ranevoi infektsii. Novye tekhnologii i standartizatsiia v lechenii oslozhnennykh ran. S-Petersburg-M, RF; 2011. p. 58-65. (in Russ.)
  14. Anagnostakos K, Mosser P. Bacteria identification on NPWT foams: clinical relevance or contamination? J Wound Care. 2012 Jul;21(7):333-4, 336-39. doi: 10.12968/jowc.2012.21.7.333
  15. Orgill DP, Bayer LR. Negative pressure wound therapy: past, present and future. Int Wound J. 2013 Dec;10 Suppl 1:15-9. doi: 10.1111/iwj.12170
Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Neurology and Neurosurgery.
Tel. mobile +375 29 7349336,
e-mail: k-kubrakov@yandex.ru,
Konstantsin M. Kubrakov
Information about the authors:
Kubrakov Konstantsin M., PhD, Associate Professor of the Department of Neurology and Neurosurgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-6723-0589
Petukhov Uladzimir I., MD, Associate Professor, Head of the Surgery Department of the Faculty of Retraining and Advanced Training of Medical Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-4042-3978
Kornilov Artyom V., Post-Graduate Student of the Surgery Department of the Faculty of Retraining and Advanced Training of Medical Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-8709-6639
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