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Thread: Spinal Abscess - Advice Please :(

  1. #1

    Spinal Abscess - Advice Please :(

    Hi guys,

    I hope I am posting in the correct location, if not I appologise but I was hoping I could get some advice. A relation of mine currently has a spinal abscess between his C2-3 vertibrae. The abscess appears not to be growing any further but the patient has been on anti biotics for 12 weeks with no obvious signs that the abscess is shrinking acording to the MRI's taken.

    He has also declined rapidly in terms of his health and gone from reasonably active person to being bedridden. He now has a urinary tract infection, an AF condition, a tremor and his short term memory appears to be compromised.

    We have had a CT done to rule out stroke or other brain trauma and are told by our doctors that a majority of his symptoms can be attributed to this abscess. However as he has had extensive radiotherapy to the neck area in the past surgery is/was extremely risky.

    At the moment the added complication is that he is now also too ill to undergo any surgery.

    My question being, if the antibiotics appear to be doing nothing and surgery is dangerous (Apparently the abscess is near the front of his spine) what do we do? I am relativly certain that without some sort of definitive action his condition will worsen and he will simply die there before anyone decided on what to do with him.

    I appologise in advance for the sparse medical details, I am not a doctor but if you require something specifically regarding this condition I can get that for you.

    Any help you can offer would be very much appreciated

    Thanks,

    Jamie

  2. #2
    Hi,

    Did they take a culture of the abscess fluid and do a culture and sensitivity to see what antibiotics are sensitive to this bug? Have they drained it? Or is that the surgery you are referrring to?
    Are infectious disease doctors on the case?
    This situation sounds very distressing.
    The question you pose- what are the options? Did you speak with the doctors about this? I would raise this question to them.

    AAD

  3. #3
    Hi there,

    Firstly thanks for your reply. As far as I am aware they have took no sample of the abscess or the fluid (We were not told they did) I am assuming that this is because of the location.

    I will pose the question though as what you are saying makes perfect sense, if you can identify the infection you can identify which antibiotics are best to use against it.

    The paper I read last night on the BMJ site mentions a case of a patient who had a similar problem but the infection was MRSA and thus non responding to antibiotics, I assume if this is the case the only option is surgery?

    I believe the only people looking at this case is the consultant Neurosurgeon who's course of action so far has to been to sit tight and wait for the antibiotics to work. However my gut feeling is if they were going to work they would have done so by now.

    I will ask about the sample and trying to identify the bacteria ASAP.

    Thanks again,

    Jamie

  4. #4
    Hi there,

    We spoke with the doctors, Apparently they cannot get a sample of the abscess as the procedure required is as dangerous as doing a decompression etc anyway.

    However they are taking blood tests to determine what the infection is, however everytime they take blood they pretty much end up changing the antibiotics each time (As I assume the infection is different every time)

    We have seen no obvious improvment and the abscess is apparently still the same size.

    Can anybody offer any suggestions as to what to do next? Last time we spoke the consultant said they were the only options, wait for the antibiotics to take hold or operate, and now he is so ill that operating is apparently out of the question.

    Second opinion perhaps? Any case studies I can refer to?

    Many thanks,

    Jamie

  5. #5
    Senior Member
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    hi jamie,

    what type of spinal abscess do you have? i had an intramedullary abscess that was incised and drained. when the neurosurgeon finally did the surg i was paralyzed from the chest down and nearly unresponsive. the culture showed a strep bacteria. it was located at C5 and extended to T2 causing me to have an incomplete C5-7 sci. i was treated with two types of i.v. abx. i spent 3 weeks in an icu and then 8weeks at ric.

    there is also epidural abscesses...i do not know much about them. i think they are above the dural layer (forms the blood brain barrier) and may be easier to treat than an intramedullary.


    please im me if you need further info. my best wishes and prayers.

  6. #6
    Senior Member fishin'guy's Avatar
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    You know the typical infection of the spine is treated with IV antibiotics, LONG time antibiotics, like 6 months to claer the infection. I hope your friend is doing okay.

  7. #7
    I don't think we are talking about spinal osteomyelitis here, but instead abscesses within the tissue of the spinal cord or under the menengies. The usual treatment for these is surgical drainage and then antibiotics for soft tissue (not bone) which usually are used for 10-14 days IV. Unfortunately is it common that either the surgery to remove the abscess or the pressure of the abscess itself may have already cause permanent damage before the diagnosis is made.

    (KLD)

  8. #8
    Hi guys,

    Indeed it is a spinal abscess (Soft tissue etc) The diagnosis was quite quick and they were happy no damage was done but surgery is out of the question due to previous radiotherapy in that area.

    This is the problem we have, the antibiotics do not appear to be having any effect. I'm trying to arrange a second opinion with another consultant as I just can't see things getting any better.

    Many thanks,

    Jamie

  9. #9

    I don't think we are talking about spinal osteomyelitis here, but instead abscesses w

    Dear SCI nurse,
    My son is a c5/6 quad. He knows of 2 friends who were treated for the condition you seem to be referring to above. After the abcesss was treated the result was loss of more function and permanent damage to the spinal cord below the abcess . His question is, can these conditions be looked for as a regular preventative and catch them before they become a big problem . Such as checking every 6 months or so. Or do they come on rapidly? Sounds like one doesnt know about them till they are well under way and causing damage. Can they be scanned for earlier. like a mamogram or other screening.

    thnx

  10. #10
    Spinal cord abscess is very rare. Are you saying you son had 2 pre-SCI friends who also have abscesses? They would most likely also share risk factors: IV drug abuse, other infected wounds, recent septicemia, etc.

    MRI is best for diagnoses. Routine screening of everyone would be ridiculously expensive and of little value.

    KLD

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