spinal infections treatment (3) indications for surgical rx –unable to obtain diagnosis by closed...
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Spinal InfectionsTreatment (3)
• Indications for surgical Rx
– Unable to obtain diagnosis by closed means
– Significant abscess formation
– Failed medical Rx (antibiotics / immobilisation)
including intolerance
– Bone destruction with deformity / instability
– Progressive neurological deficit
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Spinal InfectionsTreatment (4)
• Principles of surgical Rx
– excise necrotic tissue back to healthy margins
– decompress spinal canal where necessary
– tissue samples for microbiology / histology
– reconstruction / stabilisation of defect
approach and technique dictated by spinal level and
region to be debrided
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Spinal InfectionsOutcome (1)
• Successful non-op Rx predicted by
– age < 60 years
– immune competence
– S aureus infection
ESR (or other inflammatory index)
(in absence of indication for surgical Rx)
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Spinal InfectionsOutcome (2)
• Surgical Rx outcome
– less chronic back pain overall (cf non-op)
– related to pre-op neurological status
(quad < paraplegic < paraparesis)
– epidural abscess < granulation tissue
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TB Spine
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Predisposing factors
• HIV and Acquired Immuno-deficiency Syndrome
• Socially deprived
• Ageing population
• Intra-venous drug abuse
• Previous infections or malignancy
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Clinical Presentation
• Constitutional• Local• Deformity
-Knuckle (collapse of one vertebra)
-Gibbus deformity (more than one vertebra)• Cold abscess (retropharyngeal/chest/psoas abscess)• Paraplegia
-Early onset
Late-onset
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Investigations
• WBC • ESR• CRP• Chest x-ray• Mantoux or Heaf skin test• Enzyme-linked immunosorbent assay (ELISA) • Polymerase chain reaction (PCR)• Plain radiographs• CT scan • MRI scan• CT guided biopsy (histological or microbiological confirmation)
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D/D
1-Brucellosis
2-Malignancy
3-Pyogenic osteomyelitis,
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Management
Medical treatment
• Rest/Plaster jacket/Multi-drug anti-tuberculous chemotherapy
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Surgical Treatment• Decompression, correction of deformity & anterior
spinal fusion
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Thoracic TB - MRI
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Thoracic Tuberculosis - Postoperative Appearances