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Spinal Infections Treatment (3) Indications for surgical Rx –Unable to obtain diagnosis by closed means –Significant abscess formation –Failed medical.

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Presentation on theme: "Spinal Infections Treatment (3) Indications for surgical Rx –Unable to obtain diagnosis by closed means –Significant abscess formation –Failed medical."— 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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