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Spinal Infections Treatment (3)

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Presentation on theme: "Spinal Infections Treatment (3)"— Presentation transcript:

1 Spinal Infections Treatment (3)
Indications for surgical Rx Unable to obtain diagnosis by closed means Significant abscess formation Failed medical Rx (antibiotics / immobilisation) including intolerance Bone destruction with deformity / instability Progressive neurological deficit

2 Spinal Infections Treatment (4)
Principles of surgical Rx excise necrotic tissue back to healthy margins decompress spinal canal where necessary tissue samples for microbiology / histology reconstruction / stabilisation of defect approach and technique dictated by spinal level and region to be debrided

3 Spinal Infections Outcome (1)
Successful non-op Rx predicted by age < 60 years immune competence S aureus infection  ESR (or other inflammatory index) (in absence of indication for surgical Rx)

4 Spinal Infections Outcome (2)
Surgical Rx outcome less chronic back pain overall (cf non-op) related to pre-op neurological status (quad < paraplegic < paraparesis) epidural abscess < granulation tissue

5 TB Spine

6 Predisposing factors HIV and Acquired Immuno-deficiency Syndrome Socially deprived Ageing population Intra-venous drug abuse Previous infections or malignancy

7 Clinical Presentation
Constitutional Local Deformity -Knuckle (collapse of one vertebra) -Gibbus deformity (more than one vertebra) Cold abscess (retropharyngeal/chest/psoas abscess) Paraplegia -Early onset Late-onset

8 Investigations WBC ESR CRP Chest x-ray Mantoux or Heaf skin test
Enzyme-linked immunosorbent assay (ELISA) Polymerase chain reaction (PCR) Plain radiographs CT scan MRI scan CT guided biopsy (histological or microbiological confirmation)

9 D/D 1-Brucellosis 2-Malignancy 3-Pyogenic osteomyelitis,

10 Management Medical treatment
Rest/Plaster jacket/Multi-drug anti-tuberculous chemotherapy

11 Surgical Treatment Decompression, correction of deformity & anterior spinal fusion

12 Thoracic TB - MRI

13 Thoracic Tuberculosis - Postoperative Appearances

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