spinal infection Flashcards
what is spondylodiscitis?
Infection of the intervertebral disc and neighbouring vertebral body due to haematogenous spread
what are the principles of punjabi and white?
Ability of the spine under normal physiological load to withstand displacement that may cause pain, deformity and neurology
what are the indications for fixation in spinal infection?
- instability
- presence of neurology
- unrelenting back pain
- no improvement or worsening clinical condition
- need for an open sample
do you put metalwork in the spine in the presence of infection?
if the spine is unstable then yes
what are the aims of fixation for spinal infection?
- stabilise spine
- allow mobilisation
- prevent neurological deterioration
principles of spinal fixation for infection?
- 3 levels above and below
- don’t end at a junctional level due to stress risers
what are the radiological features of spondylodiscitis?
- early end plate involvement (late in tumour)
- no involvement of posterior elements
- no posterior bulge
- disc involvement
- no skip lesions
what are the principles of conservative treatment?
- follow BASS guidance
- MDT approach
- Antibiotics
- 6 weeks IV and 6wk oral
*anti staph and broad spectrum - monitor inflammatory markers, LFTs and UEs
- Brace
- 3 months for everyone unless not tolerated
- provides pain relief and support
- standing xray out of brace at 3 months - too look for deformity - if normal stop brace
Do you routinely get a follow up MRI scan for spondylodiscitis?
No, only if:
- worsening clinical condition
- new neurology
- to check if abscess fully drained after drainage
how do you assess patients with spinal infection?
clinical
- sources of infection
- neurology/ pain/ mobility
- factors making patients susceptible
- constitutional symptoms
Biochemical
- bloods - inflammatory markers, blood cultures, LFTs
- CT guided biopsy
radiological
- MRI whole spine - look for canal involvement/ abscesses/ skip lesions
- CT - bone destruction
- Standing xray - look for deformity
what are the routes for inoculation?
- haematogenous - most common
- direct inoculation - epidural/ spinal surgery
- continuous spread from retroperitoneal or retrophalangear
what are the most common pathogens
- staph - most common in adults
- strep - children
- gram neg, Ecloi, pseudomonas - immunocompromised
what does BASS say about CT guided biopsy?
- try to get in all patients
- if patient is septic then don’t delay treatment
- if commenced treatment and no improvement - hold Abx for 48hrs and then try to get them
- if on abx and clinically improving - not indicated
Are blood cultures sufficient for spondylodiscitis?
- 15% of positive blood cultures don’t show the actual pathogen
- only 33% are positive in spondylodiscitis
