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Published on: June 23, 2020
Update on the Diagnosis and Management of Spinal Infections
Abstract:
Pyogenic spinal infections are uncommon, but their incidence has increased. Diagnosis is based on clinical, laboratory, and imaging findings. Delayed diagnosis occurs frequently and can lead to poor outcomes. Early radiographic findings are nonspecific; MRI is the best imaging study for diagnosis. The goal of treatment is to eradicate infection, prevent recurrence, preserve spinal stability, avoid deformity, relieve pain, and prevent or reverse neurologic deficit. Current guidelines recommend antibiotics be administered for 6 weeks if there is resolution of symptoms and normalization of inflammatory parameters. Surgery is required in patients with neurologic deficit, uncontrolled sepsis, spinal instability, deformity, and failure of medical treatment and to manage epidural abscess. Classic treatment of epidural abscess is surgical, but recent studies have challenged this approach. Surgical techniques used to manage these infections are varied; they include anterior, posterior, and combined approaches, and minimally invasive surgery. Current management has decreased mortality; however, the prognosis is affected by treatment failure, recurrent infection, or potential of persistent disability secondary to deformity, chronic pain, or permanent neurologic impairment.
Insights
Pyogenic spinal infections are increasingly diagnosed using MRI, with treatment focusing on antibiotics and surgery for severe cases. Early diagnosis and intervention are crucial for better outcomes and preventing long-term disability.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Pyogenic spinal infections, though uncommon, are rising in incidence.
- Delayed diagnosis frequently leads to poor patient outcomes.
- Early radiographic findings are often nonspecific, making Magnetic Resonance Imaging (MRI) the preferred diagnostic modality.
Purpose of the Study:
- To review the current diagnostic and treatment strategies for pyogenic spinal infections.
- To highlight the importance of early diagnosis and appropriate management.
- To discuss the evolving role of surgery in managing spinal epidural abscesses.
Main Methods:
- Review of clinical, laboratory, and imaging findings for diagnosis.
- Assessment of treatment goals including infection eradication, stability preservation, and neurologic recovery.
- Evaluation of current antibiotic guidelines (6-week duration) and surgical indications.
- Discussion of various surgical techniques (anterior, posterior, minimally invasive).
Main Results:
- MRI is the optimal imaging modality for diagnosing spinal infections.
- Treatment aims to prevent recurrence, preserve spinal stability, and reverse neurologic deficits.
- Surgery is indicated for neurologic compromise, sepsis, instability, deformity, or treatment failure.
- While mortality has decreased, long-term disability remains a concern.
Conclusions:
- Prompt diagnosis and comprehensive management are essential for pyogenic spinal infections.
- The management strategy must be individualized based on clinical presentation and infection severity.
- Ongoing research may further refine treatment protocols, particularly for epidural abscesses.
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