Vertebral Osteomyelitis (also called spinal osteomyelitis , spondylodiscitis , or infection of disk space ), is a type of osteomyelitis. (Which is an infection and inflammation of bone and bone marrow). Vertebral osteomyelitis is a rare bone infection that is concentrated in the spinal region. The case of vertebral osteomyelitis is so rare that only 2-4% of all bone infections are associated with the disease. Infection can be classified as acute or chronic depending on the severity of the onset of the case, where acute patients often experience better outcomes than those living with chronic symptoms that are characteristic of the disease. Although vertebral osteomyelitis is found in patients in various age ranges, infections are usually reported in older children and adults. Vertebral osteomyelitis often attacks two vertebrae and associated intervertebral disks, causing narrowing of disk space between the vertebrae. The prognosis for this disease depends on where the infection is concentrated in the spine, the time between early onset and treatment, and what approach is used to treat the disease.
Video Vertebral osteomyelitis
Signs and symptoms
This disease is known for its fine onset in patients, and some symptoms characterize vertebral osteomyelitis. The exact diagnosis of the disease is often delayed for an average of six to twelve weeks due to ambiguous ambiguous symptoms.
General Cases
Common symptoms found in cross-sectional patients with vertebral osteomyelitis include fever, swelling at the site of infection, weakness in the vertebral column and surrounding muscles, night sweats episodes, and difficulty transitioning from a standing position to a sitting position. Additionally, persistent back pain and muscle spasms can become so debilitating that they limit the patient to a sedentary state, where even a slight movement or body shock results in extreme pain. In children, the presence of vertebral osteomyelitis can be characterized by these symptoms, along with high levels of fever and an increase in the number of body leukocytes.
Advanced Cases
Patients with advanced cases may show some or no symptoms associated with general cases of vertebral osteomyelitis. When osteomyelitis is isolated in the back, as in vertebral osteomyelitis, patients will report muscle spasm coming from behind, but may not report any fever. Symptomatic signs vary in each patient and depend on the severity of the case. Neurological deficiency characterizes cases of advanced and threatening disease. On average, 40% of patients with advanced vertebral osteomyelitis cases have some type of neurologic deficiency; this is a sign that the infection has grown for some time. In advanced cases, untreated infections will invade the nervous system through the spinal cord that runs parallel to the vertebral column, placing the patient at risk for limb paralysis. In addition, the loss of the ability to move is a symptom of the trademark of neurological problems in the case of advanced vertebral osteomyelitis. Further signs of neurologic deficits indicate an advanced case of vertebral osteomyelitis requiring immediate intervention to prevent further threats to the spinal cord.
Maps Vertebral osteomyelitis
Cause
An important aspect of this disease is found in its ability to start anywhere in the body and spread to other areas through the bloodstream. A number of bacterial strains can enter the body in this way, making the origin of the infection difficult to trace; thus, for many patients with infections, these characteristics can delay an accurate diagnosis and prolong suffering. The most common microorganisms associated with vertebral osteomyelitis are bacteria staphylococcus aureus . Another strain of staphylococcus aureus , commonly known as Methicillin-resistant Staphylococcus aureus (MRSA), is a very dangerous microorganism that is more difficult to treat than other related strains. Streptococcus equisimilis may also be responsible for the onset of vertebral osteomyelitis, although considered less virulent than staphylococcus aureus .
Diagnosis
The diagnosis of vertebral osteomyelitis is often complicated because of the delay between the onset of the disease and the initial appearance of symptoms. Before pursuing radiological testing methods, doctors often order a complete blood test to see how the patient levels are compared to normal blood levels in a healthy body. In a complete blood test, C-reactive protein (CRP) is an indicator of infection rate, full blood count (CBC) evaluating the presence of white and red blood cells, and blood-stroke level (ESR) tests for inflammation in the body. Anomalous values ​​that fall outside the acceptable range in one of these subcategories confirm the presence of infection in the body and indicate that further diagnostic action is required. Blood tests may prove unconvincing and may not serve as sufficient evidence to confirm the presence of vertebral osteomyelitis. Diagnosis can also be complicated because of the similarity of disease with discitis, commonly known as disk space infections. Both diseases are characterized by patients' inability to walk and concentrated back pain; However, patients with vertebral osteomyelitis often appear to be more painful than those with discitis. Additional action may be required to override the possibility of discitis; Such approaches include diagnosing the disease through various medical imaging techniques.
Radiological Diagnosis
Radiological interventions are often necessary to confirm the presence of vertebral osteomyelitis in the body. Plain radiological film commands are required for all patients showing symptoms of the disease. This diagnostic approach is often earlier than other radiological procedures, such as magnetic resonance imaging, or MRI, computed tomography (CT) scans, fine needle aspiration biopsy, and nuclear scintigraphy. The first plain-scratch X-ray images were scanned for an indication of compression of the disc between two vertebrae or degeneration of one or more vertebrae. Only when these findings are ambiguous is further testing is needed to diagnose the disease. Other radiological approaches offer a more comprehensive imaging of the spinal area, but can often prove discomfort. MRI scans do not expose the patient to radiation and are very sensitive to changes in the size and appearance of intervertebral discs; However, the findings on an MRI scan may be confused with other conditions such as the presence of a tumor or a fracture. If imaging MRI can not be concluded, high sensitivity to erosion of vertebral or intervertebral segments of CT scan may be preferred because their ability to show signs of illness is more pronounced than MRI. Additional tests may be ordered if the preliminary test can not confirm the diagnosis; for example, needle biopsy may be required to take a sample of bone surrounding the disk space where the infection is alive, or nuclear bone scanning can be used to differentiate the healthy bone area from the infection area.
Treatment
Treatment options for vertebral osteomyelitis depend on the severity of the infection. Because the use of intravenous antibiotics seems to eliminate responsible pathogens in most cases of vertebral osteomyelitis, doctors often perform non-surgical interventions before considering surgical options.
Non-surgical intervention
Non-surgical intervention is often desirable because it has a smaller risk to the body of further infections that can occur if the body does not need to be exposed to other outside pathogens during surgery. Intravenous antibiotics can be prescribed to kill the infectious microorganisms. These antibiotics are administered at a continuous level for various times, lasting from four weeks to several months. Results for patients undergoing intravenous infusion were different according to factors such as age, immune system strength, and blood sedimentation rate (LED). If the intervention through antibiotics fails, the patient is directed to a surgical treatment option.
Surgical intervention
Surgery may be necessary for patients with advanced vertebral osteomyelitis cases. Spinal fusion is a common approach to destroying the microorganisms that cause disease and rebuilding the part of the spine lost due to infection. Fusion can be approached anteriorly or posteriorly, or both, depending on where the infection lies in the vertebral region. Spinal fusion involves clearing the infected spine area and inserting instrumentation to stabilize vertebrae and disk. Such instrumentation often includes bone grafts taken from other areas of the body or from bone banks, where bone fragments are drawn from deceased donors. New bone graft is secured in the right spinal region through the use of supporting rods and screws, which are mostly made of titanium. Rods of this material promote healing and bone fusion more efficiently than stainless steel rods and are also more visible on MRI.
Prognosis
Mortality rates were recorded higher in patients whose infection was caused by bacteria staphylococcus aureus . However, if diagnosed quickly and treated correctly, patients with staphylococcus aureus experience better results than those with disease caused by other microorganisms. Gradual osteomyelitis vertebral progression places the patient at risk of paralysis, especially if the infection is concentrated in the thoracic or cervical spine. The study, published in the Journal of Bone and Joint Surgery (1997) notes that most patients do not experience symptoms of infection after surgical intervention; therefore, patients with advanced vertebral osteomyelitis cases undergoing surgical approach often experience better results than those treated only through intravenous antibiotics.
See also
- Bone transplant
- Allotransplantation
- X-ray computed tomography
- Smooth needle aspiration
- Intravenous therapy
References
Source of the article : Wikipedia
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