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Pyogenic Spinal Infections

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Pyogenic Spinal Infections Pyogenic Spondylitis: Body involvement , starting in the endplates. Septic intervertebral discitis Spinal Epidural abscess – PowerPoint PPT presentation

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Title: Pyogenic Spinal Infections


1
Pyogenic Spinal Infections
  • Pyogenic Spondylitis Body involvement , starting
    in the endplates.
  • Septic intervertebral discitis
  • Spinal Epidural abscess

2
Presentation
  • Acute
  • Sub-acute - common.
  • Chronic - common
  • Average delay in diagnosis 8 weeks to 3 months.

3
Presentation
  • Usually have underlying infection source.
  • C/o Back Pain - similar to mechanical LBP.
  • Fever Only 33 gt100F( Garcia, JBJS 1960)
  • Local tenderness may or may not be present.
  • Muscle spasm /- , Psoas Abscess
  • Neurology in late cases.
  • Symptoms much more than examination findings may
    suggest

4
Diagnosis
  • Need a high index of suspicion.
  • ESR/CRP - usually high - but non-specific.
  • Bone scan - May be false negative( disc
    avascular). Or may show degenerative change
    only.
  • MRI - Best. High signal on T2 image .
  • WBC count - unhelpful
  • Blood cultures - during fever spike. /-.

5
Diagnostic pitfalls
  • No fever, no local tenderness.
  • ESR high due to other causes.
  • Bone scan negative.
  • Referred pain - abdomen,hip, chest.
  • May present with worsening of long standing
    mechanical low back pain.
  • First pass investigations may be negative in
    early disease.

6
Predisposing factors
  • Diabetes
  • Rheumatoid Arthritis
  • Other infections - urinary, chest, septicemia.
  • I/V drug abuser
  • Anti-cancer treatment
  • Long term steroid use.

7
Mangement
  • Confirm diagnosis
  • WBC, ESR, Blood Culture.
  • Percutaneous washout and biopsy in selected
    cases.
  • Antibiotics for 3 months usually

8
Organisms
  • Commonest is Staph. Aureus.
  • Pseudomonas in immuno-compromised hosts.
  • Could be Candida or TB.
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