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Diagnosis and Management of Spinal Infections

Spinal infections increased since 1990’s due to aging populations, chronic debilitating diseases and higher number of immunocompromised hosts. Management of spinal infections is still challenging because symptoms are often non-specific which leads to delayed diagnosis. However local pain in the neck and back are the main common symptoms taking place in more than 90% patients. Only few of the patients experience fever and motion of the spine is limited due to localized pain and muscle spasm. One of the useful tools used for early diagnosis of spinal infection is the magnetic resonance imaging. And it is able to yield positive finding just after 3-5 days from the onset of disease

 

Laboratory Test and Imaging

Almost 90% of patients with spinal infection demonstrate an elevated erythrocyte sedimentation rate. It also showed local pain worsening, sepsis, fever, neurologic symptoms and new local pain following recent episode of sepsis. For the pathogens identified in cultured must have appropriate antibiotics for careful consideration of antimicrobial susceptibility and spinal tissue penetration. In radiographic finding almost 74% of patients shows narrowing of the disc space. By the time of 3-6 weeks from the onset of disease reveals destructive changes such as lytic lesions of endplate. In patients with Mtuberculosis infection shows bone destruction with bone atrophy.

 

Some indications for surgical treatment include neurologic deficit, spinal instability, progressive deformity, persistent infection and unbearable pain. However the gold standard in surgical treatment in most patients is an anterior radical debridement followed by bone grafting. On the other hand patients suspected to have spinal infection due to bacteria, identification of the causative agent is very important. Cultured must me initiated from blood and from locus of infection before administering antibiotic. The rate of pathogen obtained from the disc body varies from 41%-90% which is usually collected using biopsy.

 

Indeed, the posterior to anterior debridement and strut bone grafting are recently popular in spinal infection surgery. In which this method provides faster and more complete fusion and better bone correction. However in some cases recurrent infection occurs after spinal instrumentation.

 

Sources: Prepared by Joan Tura from  Journal of Orthopaedic Science

Volume 23, Issue 1, January 2018, Pages 8-13