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spinal infection
Etiology:
- Staphylococcus aureus (most common)
- risk factors
- indwelling venous catheter
- AV fisutla
- diabetes mellitus
- hemodialysis
- intravenous drug abuse
- immunosuppression
- malignancy
Epidemiology:
- uncommon
- more common in elderly
Pathology:
- generally occurs via hematogenous spread from another site, frequently bacterial endocarditis
- intervertebral disc infection (75%)
- generally accompanied by vertebral osteomyelitis
- isolated vertebral osteomyelitis
Clinical manifestations:
- back pain (most common)
- spinal tenderness variable
- fever (50%)
- straight leg raising may be positive
- neurologic signs < 1/3 of cases
- lower extremity muscle weakness
- sensory impairment
Laboratory:
- complete blood count
- leukocytosis (50-60%)
- erythrocyte sedimentation rate & serum C-reactive protein increased in > 90% of patients
- blood cultures
Radiology:
- plain films not diagnostic
Complications:
- abscess requiring drainage &/or prolonged antibiotic therapy
- spinal cord infection
- paralysis
Management:
- see vertebral osteomyelitis
Specific
vertebral osteomyelitis
General
infection (infectious disease)
References
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Hutchinson C, Hanger C, Wilkinson T, Sainsbury R, Pithie A
Spontaneous spinal infections in older people.
Intern Med J. 2009 Dec;39(12):845-8.
PMID: 20233246
- Bernard L et al.
Antibiotic treatment for 6 weeks versus 12 weeks in patients
with pyogenic vertebral osteomyelitis: An open-label, non-
inferiority, randomised, controlled trial.
Lancet 2014 Nov 5;
PMID: 25468170
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961233-2/fulltext
- Lora-Tamayo J and Murillo O.
Shorter treatments for vertebral osteomyelitis.
Lancet 2014 Nov 5
PMID: 25468169
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961936-X/fulltext