Prof. Dr. Yavor Enchev, MD: If you have severe neck or back pain, see a doctor

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Prof. Dr. Yavor Enchev, MD: If you have severe neck or back pain, see a doctor
Prof. Dr. Yavor Enchev, MD: If you have severe neck or back pain, see a doctor
Anonim

Prof. Dr. Yavor Enchev, MD, is the head of the Neurosurgery Clinic of the University Hospital "St. Marina", city of Varna; is the vice-chairman of the Bulgarian Society of Neurosurgery and a leading expert in the field of neurosurgical treatment of diseases of the spine - spinal surgery. Prof. Enchev has been leading the clinic since its foundation in 2011. He teaches at MU-Varna.

He graduated with full honors from Medical University - Sofia in 2000 and won the "Golden Hippocrates" award, which gives him the right to specialize in a speci alty of his choice for free. Without hesitation, he chooses the career of a neurosurgeon.

An important period of his many specializations around the world is the five-month internship in Helsinki with one of the biggest brain aneurysm specialists - Prof. Juha Hernesniemi from Finland. He studied surgical techniques for the operation of vascular malformations under Prof. Helmut Bertalanffy in Germany. He is a student of Prof. Shizuo Oi - a world authority in pediatric neurosurgery.

Dr. Yavor Enchev and I talk about inflammatory diseases of the spine, about which too little is known. For this and other reasons, patients are often diagnosed late and, moreover, treated incorrectly.

Prof. Enchev, let's start with the standard question: what are inflammatory diseases of the spine?

- It is about the so-called vertebral osteomyelitis (inflammation of the vertebrae), spondylodiscitis (inflammation of the vertebrae and intervertebral disc) and epidural abscesses (a collection of pus in the spinal canal). They can be non-specific, caused most often by staphylococci.

Or specific due to the causative agent of tuberculosis. In this regard, I want to note that in recent decades, tuberculosis has made a comeback, and it is now a grim reality, including involving the spine. There is another separate group of inflammatory diseases of the spine, it is about postoperative complications, but they are not the subject of this interview.

What is the frequency of spondylodiscitis?

- In the past, they were considered rare diseases, but, unfortunately, in recent years, their frequency has significantly increased in the country. The reasons include the aging population, the growing number of uninsured patients, the low he alth culture and poor socio-living conditions of some people, self-diagnosis and self-treatment, late seeking of medical help.

And hence the untimely diagnosis and wrong treatment of other inflammatory diseases in the human body. Therefore, inflammatory diseases of the spine should always be considered in the differential diagnosis of diseases of the spine.

How do spinal inflammations occur?

- They are most often a consequence of other untreated inflammatory diseases. Because the inflammation is transferred to the vertebrae or the disc by means of the blood or uroinfections, pulmonary inflammations, dental infections, endocarditis, thrombophlebitis, or adjacent to disease of the surrounding soft tissues.

In blood spread, a thrombus of bacteria blocks the feeding artery of the vertebra, or less commonly, the infection is transferred from inflamed veins around the vertebrae. As a result, pus collections form in the vertebrae, which destroy their bone structure, and subsequently the inflammation involves the intervertebral disc and the surrounding soft tissues.

For what complaints should patients suspect that they may have inflammation of the spine or spondylodiscitis in order to seek medical attention?

- Patients usually complain of severe pain in the neck, lower back, or back, with or without radiating pain to the arms, chest, or legs. The pain increases with movement, and this is the reason why patients take a forced posture. Patients typically wake up at night when turning in bed. Some of them have high fever, lack of appetite and weight loss.

How is spondylodiscitis diagnosed?

- Diagnosis is based on laboratory and imaging studies. From the laboratory tests, the values of C-reactive protein and not always those of leukocytes are important: highly elevated, they are a non-specific sign of an active inflammatory process. Of the imaging diagnostics with the greatest informative value is the MRI-examination with data on purulent collections in the vertebrae, disc and paravertebral soft tissues and muscles, complemented by the CT-examination with data on bone destruction and changed configuration of the spine.

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Prof. Dr. Yavor Enchev

Prof. Enchev, what is the treatment of spondylodiscitis?

- The treatment of spondylodiscitis has two aspects - conservative antibiotic and operative treatment. Antibiotic treatment is mandatory, regardless of whether it is combined with surgery or not. Very rarely do we have an antibiogram to assess the exact bacterial causative agent and to which specific antibiotics it is sensitive. That is why the antibiotics that are administered are broad-spectrum and are placed intravenously for 4-6-8 weeks, with weekly control of C-reactive protein.

In the case of tuberculous inflammation of the spine, specific treatment with tuberculostatic agents is applied for a period of about 6 months, with monitoring for toxic reactions. Operative treatment is performed in patients with vertebral destruction and subsequent spinal instability. As well as those with neurological symptoms - pain and paresis.

A collection of pus in the spinal canal, known as an epidural abscess, is another indication for neurosurgical treatment. Operative treatment allows rapid functional recovery and prevents deformation of the spine, as well as possible subsequent damage to the spinal cord and spinal nerves. Operative treatment aims to evacuate the pus collection, stabilize the spine in the area of the destroyed vertebrae and remove the compression of the compressed spinal cord and nerves.

The operation is performed in two stages. In the first one, stabilization of the spine is carried out with transpedicular screw stabilization in the lumbar and thoracic department, and with a cage and plate in the cervical department. The second stage involves evacuation of pus and decompression of the compressed spinal cord and nerves.

How is the postoperative period for these patients?

- On the first postoperative day, patients undergo a control CT-examination to evaluate achieved decompression and stabilization. The operative drain is then removed and the patient is uprighted and ambulated. Three to four days after the operation, the patient is discharged, and the antibiotic treatment continues until the normalization of the C-reactive protein in a home environment.

And what does the rehabilitation of patients with spondylodiscitis include?

- Patients operated on for spondylodiscitis should be physically active postoperatively to reduce the risk of thrombophlebitis of the lower extremities. Those who have severe residual neurological symptoms need active rehabilitation.

Is there a prevention of spondylodiscitis?

- There is no clearly defined and generally accepted prevention of spondylodiscitis. However, in the literature, caution is recommended in patients with diabetes, uro- and nephroinfections, as well as in patients with prolonged infectious diseases.

The risk in these patients for the development of inflammatory diseases of the spine is greater. In conclusion, allow me to point out that one of the best places for treatment of these diseases is the Neurosurgery Clinic of UMBAL "St. Marina", city of Varna.

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