Spine infection
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Transcript of Spine infection
SPINE INFECTION
NOOR HAFIZAH BINTI HASSAN2007287236
CONTENTS:
1) PYOGENIC SPINE INFECTION:- OSTEOMYELITIS OF THE SPINE- DISCITIS
2) NON PYOGENIC (GRANULOMATOUS) SPINE INFECTION:- TUBERCULOUS SPINE INFECTION
PYOGENIC SPINE INFECTION
EPIDEMIOLOGY
AETIOLOGY
• Bacterial : Staph aureus (70 %) : Streptococcus sp. : E.coli : Pseudomonas IVDU
• Location: Lumbar spine : Thoracic spine : Cervical spine
↑ vascularity
PATHOPHYSIOLOGYROUTES OF INFECTION SPREAD:
HEMATOGENOUS SPREAD
1) Differences in blood supply in children and adult:
2) Blood supply of the vertebrae:
Batson’s plexus
CLINICAL PRESENTATION
• Back / neck pain
• Constitutional symptoms
– Fever / malaise / anorexia
• Neurological deficit:
– according to the level of vertebra
• Non specific in children
• o/e: tenderness, limited ROM
RED FLAG OF BACK PAIN:
• AGE <15 OR >55• THORACIC BACK PAIN• NIGHT PAIN•CONSTANT & PROGRESSIVE S/SX•FOCAL NEUROLOGICAL DEFICIT•HX OF MALIGNANCY• IVDU• IMMUNOCOMPROMISED
INVESTIGATION• Aim of investigation • Laboratory investigation:– FBC: ↑ WCC
: anemia of chronic disease– BLOOD C&S– ESR: > 50 mm/hr– CRP– LIVER FUNCTION TEST– RENAL PROFILE
• Radiological investigation:a) Plain x-ray:
Narrowing of Narrowing of intervertebral spaceintervertebral space
Destruction of Destruction of vertebral bodyvertebral body
b) CT scan:
Axial view of cervical vertebra:Axial view of cervical vertebra:Destruction of vertebral bodyDestruction of vertebral body
c) MRI with contrast enhancement:
Collapse of vertebral bodyCollapse of vertebral bodyRetropulsed bony fragment Retropulsed bony fragment compressing the spinal cordcompressing the spinal cord
TREATMENT
MEDICAL:• CRIB• Analgesia• Intravenous abx 4-6/52
↓ improvement
• Oral abx 6-8/52• Spinal brace
SURGICAL:• Indications:
• Failed medical treatment• Presence/development of
neurological signs • Drainage of soft tissue
abscess• Methods:
• Decompression • Stabilization
DISCITIS• Routes of infection spread:
– Iatrogenic: following procedure eg discectomy adult– Non iatrogenic: blood-borne children
• Clinical presentation:– Acute back pain / muscle spasm / systemic features
• Destruction of vertebral end plate spread to v/body• Raised ESR• Management:
– Iatrogenic: prevention!! : broad spectrum abx
– Non iatrogenic: usually self limiting
NON PYOGENIC SPINE INFECTION:
(TUBERCULOUS SPONDYLITIS)
EPIDEMIOLOGY• Extrapulmonary Tb: 20-25 % of reported case
• Skeletal Tb: 1-3 %, with spine preference
• M. Dharmalingam. Tuberculosis of the spine—the Sabah
experience. Epidemiology, treatment and results.
Tuberculosis (Edinb). 2004;84(1-2):24-8.– 33 patient (24 Males, 9 Females)– Peak incidence: 20s– Prior hx of pulmonary Tb: 66.6 %– Vertebral involvement: thoracic ( 30.3 %) > lumbar (27.2 %)
PATHOPHYSIOLOGY
Abscess
Preservation of Preservation of intervertebral discintervertebral disc
Collapse of Collapse of vertebral bodyvertebral body
Rarefaction the Rarefaction the anterior aspect of anterior aspect of
vertebral bodyvertebral body
CLINICAL PRESENTATION
• Long h/o backache
• Prior h/o pulmonary Tb or
exposure to Tb patient
• Deformity
• Cold abscess
• Paresthesia / weakness
• On examination:
- Pulmonary signs
-Angular thoracic
kyphos
- Local tenderness
- Gibbus
- Limited ROM
- Neurological exam
POTT’S PARAPLEGIA
• The most feared complication
• Early onset paresis:– Weakness of LL, UMN features, sensory dysf(x)– d/t pressure by the abscess/caseous material/
bony fragment
• Late onset: – d/t deformity/reactivation of the disease/cord
ischemia
INVESTIGATION
a) Laboratory investigation:– FBC– BLOOD C&S– ESR & CRP– LFT– RP– Mantoux test
b) Radiological investigation:– Plain x-ray:• Narrowing of i/vertebral
space• Fuzziness of end plates• Collapse of adjacent
vertebral body• Paraspinal soft tissue
shadow
– CT scan & MRI• Cord compression
T9Narrowing of Narrowing of intervertebral discintervertebral disc
Soft tissueSoft tissueshadowshadow
Soft tissueSoft tissuemassmass
Destruction of Destruction of vertebral bodyvertebral body
TREATMENT• Aim of treatment:
– To eradicate or at least arrest the disease– To prevent or correct deformity– To prevent or treat complication – paraplegia
• Medical treatment:– Anti-Tb chemotherapy 9/12– Continuous bed rest
• Surgical treatment:– To drain abscess– To correct deformity
FIRST LINE TB DRUGS
THANK YOUTHANK YOUREFERENCES:REFERENCES:
1. 1. Spinal infections. Jonathan A Clamp and Michael P Grevitt. Elsevier Ltd.
2. 2. Theodore Gouliouris, Sani H. Aliyu, and Nicholas M. Brown. Spondylodiscitis: update on diagnosis and management. J. Antimicrob. Chemother. (2010) 65 (suppl 3): iii11-iii24.
3. Peter Martin.Pyogenic osteomyelitis of the spine. British 3. Peter Martin.Pyogenic osteomyelitis of the spine. British Medical Journal, Nov 9 1946.Medical Journal, Nov 9 1946.
Extra notes: red flag of back pain
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