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[Infectious spondylitis--diagnosis and therapy]
1Rheumatologische Universitätsklinik, Inselspital, Bern.
Abstract:
Spinal infections usually develop as pyogenic osteomyelitis originating from hematogenous seeding of staphylococci, escherichia coli or pseudomonas. They present with pain at rest, general symptoms, elevated ESR and radiographic findings after several weeks. Magnetic resonance imaging is the current technique of choice. Individual antibiotic treatment is established according to the sensitivity of the cultured organism. Some patients need surgical interventions in case of neurologic deficits, abscesses, chronic fistulas, severe bone destructions and unsuccessful nonoperative treatment.
Insights
Spinal infections, often pyogenic osteomyelitis, present with pain and systemic symptoms, diagnosed via MRI. Treatment involves targeted antibiotics, with surgery for complications like neurological deficits or severe bone destruction.
Area of Science:
- Spinal infections
- Pyogenic osteomyelitis
- Hematogenous seeding
Context:
- Spinal infections typically manifest as pyogenic osteomyelitis, frequently arising from hematogenous spread of bacteria like Staphylococcus, Escherichia coli, or Pseudomonas.
- Clinical presentation includes rest pain, constitutional symptoms, elevated erythrocyte sedimentation rate (ESR), and delayed radiographic evidence.
Purpose:
- To outline the typical presentation, diagnostic modalities, and management strategies for spinal infections.
- To highlight the role of Magnetic Resonance Imaging (MRI) as the preferred diagnostic tool.
- To delineate indications for surgical intervention in spinal infections.
Summary:
- Pyogenic spinal osteomyelitis commonly results from hematogenous bacterial seeding.
- Diagnosis relies on clinical signs, elevated ESR, and advanced imaging, particularly MRI.
- Treatment is tailored, involving antibiotics based on microbial sensitivity and surgical management for specific complications.
Impact:
- Early and accurate diagnosis of spinal infections is crucial for effective management.
- MRI provides superior visualization for diagnosing spinal osteomyelitis.
- Appropriate antibiotic therapy and timely surgical intervention improve patient outcomes and prevent long-term sequelae.