"What are they? How are they treated?"
What are spinal infections?
The vertebral column (bones), the intervertebral discs, the dural sac (the covering around the spinal cord) or the space around the spinal cord may become infected in a number of circumstances. The infection may be caused by bacteria or fungal organisms.
Spinal infections may occur following surgery or spontaneously in patients with certain risk factors. Risk factors for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, diabetes and obesity.
The most common infection in Indian Scenario is Tuberculosis .
Also Postoperative infections are known .
Surgical risk factors include a long surgical time, instrumentation and re-operations. Infections occur in up to 4% of surgical cases despite the numerous preventative measures that are taken. The likelihood of an infection increases with the number of operations in an area. Most postoperative infections occur between three days and three months after the time of surgery.
What are the symptoms of spinal infection?
In Tuberculosis, there may or may not be associated constitutional symptoms like Fever (Evening rise of temperature), malaise, night sweats, Loss of weight and appetite etc.... along with pain in the area of affection in the spine.
The symptoms of a postoperative spinal infection include fever, chills, headache, neck stiffness, pain, wound redness and tenderness, and wound drainage. In some cases, patients may notice new weakness, numbness or tingling sensations in the arms and/or legs. The symptoms may be very severe, or they may be very subtle in some cases.
How is a spinal infection diagnosed?
The diagnosis of a spinal infection begins with a history and physical. You doctor will ask questions to screen for spinal infection risk factors.
Your doctor may order a series of tests to look for an infection if one is suspected. These tests may include plain X-ray imaging, computerized tomography (CT or CAT) scans or MRI scans. In some cases, further specialized testing is required when the diagnosis is still in question. These include nuclear medicine bone scans and nuclear medicine tagged white blood cell scans.
Your doctor will want to obtain cultures to determine the type of bacteria or fungus that is causing the infection. Blood cultures are often obtained to screen for evidence of infection. Cultures of your wound or the area of infection may be taken. In cases of deep infections of the vertebrae (bone) or the intervertebral disc, A needle culture may be required. This is often done with X-ray guidance with local anesthetic medication given at the needle entry site.
In Tuberculosis... A CT Guided biopsy will be useful for diagnosis and to establish the drugs that need to be given (Depending on Sensitivity of the organism) to the patient.
Biopsy: Intraosseous Lesions?
FNAC, BONE [CORE] Biopsy Needles, C-ARM Guided, USG Guided, CT Guided Biopsy
Your doctor may also order additional blood tests to screen for signs of an infection. These tests include a white blood cell (WBC) count, c-reactive protein (CRP) and an erythrocyte sedimentation rate (ESR). These values may be slightly elevated after an operation, but usually return to normal values within a few weeks. Abnormal elevation may represent a sign of infection.
What are the medical & interventional (nonsurgical) treatment options?
The nonsurgical medical and interventional management of spinal infections consists of antibiotic or anti-fungal medications. The type and the duration of the treatment depends on the severity of the infection and the organism causing the infection.
When is surgery necessary?
Surgery may be required for many postoperative infections to wash away much of the bacteria and infected tissue. In addition, surgery may be required in cases where there is evidence of instability of the spine as a result of the infection. In cases in which there is severe weakness as a result of a spinal infection, surgery may be required to relieve the pressure on the spinal cord caused by the infection.
What are the surgical options?
The surgical options to treat spinal infections range from simply washing out the wound and re-closing to more extensive debridements and removal of infected tissues.
In some cases it is not possible to close the wound at the time of surgery, and a packing dressing is left in place. This is often changed two to three times a day until the wound heals over a period of several weeks.
In Tuberculosis... there is a very good probabability of recovery with rest, Proper anti tuberculosis regimen (In association with a Tuberculosis / Chest Physician), Improving immunity, High protein diet etc..!! Mri at intervals along with clinical assessment defines healing and also helps decide the longevity of treatment.
Failure of diagnosis, lack of improvement despite treatment, Progressive neurological worsening despite adequate treatment, Late onset issues are some of the indications for surgery.
Operative intervention only in special clinical situations!
- Failure of conservative regime.
- Doubtful diagnosis?
- Significant existent or residual “spinal instabilty”
- Significant existent or residual “spinal deformity”
- Significant or residual “neurological deficit”
Surgery can vary from mere decompression and drainage of Pus / tissue to Aggressive stabilization of spine with spinal instrumentation techniques.
This decision is Case and condition Specific!!
Non Operative treatment in a patient yielding GOOD results (as seen below) Healing of the infected spinal area with antibiotic, Rest and proper Nutrition and adequate careful monitoring at frequent follow ups.
Operative intervention for a patient who deteriorated under treatment showing good results clinic radiologically (as shown below)
Indications
Pt under Treatment for Tuberculosis of Spine
Deterioration at 2 ½ mths
post treatment conservatively
Infections
Postoperative X rays at follow up at intervals.
Indications
Infections
