Treatment algorithm for spontaneous spinal infections: A review of the literature
Fabrizio Gregori1, Giovanni Grasso2, Giancarlo Iaiani3
1Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy.
Background:
Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management.
Methods:
A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus.
Results:
Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment.
Conclusion:
A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.
Insights
Accurate diagnosis of primary spinal infections requires a systematic approach. This review proposes a management algorithm to guide clinicians in prompt and effective treatment of these rare conditions.
Area of Science:
- Infectious Diseases
- Spinal Surgery
- Diagnostic Imaging
- Microbiology
Background:
- Primary spinal infections are rare, accounting for 5% of osteomyelitis cases.
- Diagnosis can be challenging, leading to delayed identification and treatment.
- Etiological diagnosis is crucial for selecting the most effective treatment strategy.
Purpose of the Study:
- To emphasize the importance of a methodological approach for accurate and prompt diagnosis of spinal infections.
- To present a diagnostic and management algorithm for primary spinal infections.
Main Methods:
- Comprehensive literature search conducted across major scientific databases (PubMed, Scopus, Web of Science, Google Scholar, Ebsco, Embase).
- Review of diagnostic modalities including clinical suspicion, physical examination, radiological imaging, and microbiological testing.
- Analysis of indications for surgical versus conservative management.
Main Results:
- Diagnosis relies on integrating clinical findings with rational use of physical, radiological, and microbiological examinations.
- Microbiological samples should ideally be obtained before antibiotic initiation, via percutaneous or open biopsy.
- Surgical intervention is indicated for neurological deficits, sepsis, instability, deformity, epidural abscess, or treatment failure.
Conclusions:
- A multidisciplinary approach involving spinal surgeons and infectious disease specialists is essential for optimal treatment planning.
- The proposed algorithm aids in the diagnosis and management of primary spinal infections.
- Prompt and accurate diagnosis is key to successful patient outcomes.
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