بسم اللّه الرحمن الرحیم
INFECTIOUS SPONDILODISCITIS
Definition Infection of intervertebral disc and adjacent vertebrae
Microbial Agents Pyogens (Staph -E coli) Acute Brucella- Salmonella Subacute Tuberculosis Chronic
PATHOGENESIS
Hematogenous Direct inoculation Adjacent tissue
ANT POST Spinal artery
ANT POST INITIATION
ANT POST INITIATION DESTRUCTION
TUBERCULOSIS BRUCELOSIS Anterior DESTRUCTION
Anterior REPAIR
COURSE ANT INITIATION DESTRUCTION REPAIR
SPONDYLODISCITIS OF TUBERCULOSIS (POTT’S disease)
Epidemiology 2 % musculoskeletal Site: Lung involvement: 20-30% 1% spine Site: Upper thoracic: Children Lower thoracic: Adult Lung involvement: 20-30%
Clinical Manifestation
Clinical Manifestation STAGE 2 (DESTRUCTION) months 1-2 years STAGE 1 (INITIATION) STAGE 3 (REPAIR)
Clinical Manifestation STAGE 1 (INITIATION) Mechanical pain Mild tenderness
Clinical Manifestation STAGE 2 (DESTRUCTION) STAGE 1 (INITIATION) months Constitutional Severe Back pain Ph/Ex: Severe Tenderness Blockage (erect posture) Gibbous deformity Cold abscess Neurological (paraplegia)
Clinical Manifestation STAGE 2 (DESTRUCTION) STAGE 1 (INITIATION) 1-2 years STAGE 3 (REPAIR) Mechanical pain Reduce symptom Reduce spasm
DIAGNOSIS
IMAGING
RADIOGRAPHY
LAB TESTS
LAB TESTS ESR PPD (+) Sputum smear & culture Abscess or bone biopsy: Culture / Pathology
TREATMENT
TREATMENT Medical: Mainstay of treatment Alone is successful in 70% Duration: 18 m (9-12 m ?)
TREATMENT Surgical: Advanced neurological deficit Progressive Neurological deficits Kyphosis > 40 degrees
Monitoring Clinical Radiology ESR, CRP pain constitutional mobility neurological signs ESR, CRP Radiology may be progress during first 6 month of treatment
BRUCELLOSIS SPONDYLODISCITIS
EPIDEMIOLOGY Spine: 7-8% of skeletal Site: Lumbosacral (Anterior)
BRUCELOSIS
CLINICAL MANIFESTATION
CLINICAL MANIFESTATION Constitutional: Fever Night Sweat Malaise Arthralgia Apathetic Then: Severe low back pain
CLINICAL MANIFESTATION Physical examination: Blockage Severe tenderness Fever Splenomegaly Lymphadenopathy
DIAGNOSIS
DIAGNOSIS Clinical presentation Radiography Supporting laboratory finding History of potential exposure: Endemic area Microbiology laboratory Unpasteurized milk products Contact with animals History of similar illness in the family (documented in almost 50% of cases).
Laboratory WBC: NL or low ESR, CRP: NL Wright; Cooms Wright B/C or Bone marrow culture (7-35 d) ELISA
Treatment 2 Drug: 3 months Rifampin 600-900 mg/d Doxycycline 100 mg twice daily 3 months
SALMONELLA SPONDYLODISCITIS
SALMONELLA SPONDYLODISCITIS Clinical sign & radiologic future is similar to Brucellosis. Diarrhea: 60% Positive S/C (most commonly)
SALMONELLA SPONDYLODISCITIS Treatment: Quinolones Ceftriaxone For 4 w
PYOGENIC SPONDYLODISCITIS
PYOGENIC SPONDYLODISCITIS staphylococcus aureus (50 – 70%) History of recent infection (UTI; septicemia) Acute severe back pain; High fever; Chills Patient is ill. Blockage; Severe tenderness Lumbar spine (45%) Thoracic (35%)
PYOGENIC SPONDYLODISCITIS Radiography: severe destructive rapidly progressive lesion Large bone bridge
PYOGENIC SPONDYLODISCITIS MRI:
PYOGENIC SPONDYLODISCITIS Laboratory: Leucocytosis ESR (useful in fallow up) Culture B/C: 50% - 70% Biopsy: 70% - 90% UTD 19.3
PYOGENIC SPONDYLODISCITIS Diagnosis: Clinical presentation Radiology laboratory
PYOGENIC SPONDYLODISCITIS Treatment: Two drugs (Staph & gram negative organisms) Six weeks Surgery: - progressive - cord compression
Paravertebral abscess Psoas abscess Brucellosis Tuberculosis Site Lumbar and others Dorsolumbar Vertebrae Multiple or contiguous Contiguous Diskitis Late Early Body Intact until late Morphology lost early Canal compression Rare Common Epiphysitis Anterosuperior (Pom's sign) General: upper and lower disk regions, central, subperiosteal Osteophyte Anterolateral (parrot beak) Unusual Deformity Wedging uncommon Anterior wedge, gibbus Recovery Sclerosis, whole body Variable Paravertebral abscess Small, well-localized Common and discrete loss, transverse process Psoas abscess More likely