Management of Spontaneous Spinal Infection: A Review of 40 Consecutive Patients
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- Category: Vol. 80, March 2012
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Management of Spontaneous Spinal Infection: A Review of 40 Consecutive Patients, MOHAMED Y. AL-QAZAZ
Abstract
Study Design: A retrospective study of 40 cases of spon-taneous spinal infection, excluding postoperative infections. Data were obtained through medical record review, imaging examination, and patient follow-up evaluation in Neurology and Neurosurgery Departments.
Objectives: To analyze the bacteriology, pathologic entities, results and complications of treatment options.
Method: All patients received plain radiographs and gadolinium-enhanced magnetic resonance imaging scans. Patients who had been operated upon had tissue biopsies. All patients received intravenous and oral antibiotics. A total of 18 patients underwent surgery. Patient outcomes were corre-lated with clinical status, and treatment method.
Results: The study included 28 males and 12 females with mean age of 45 years. Main symptoms were back pain and fever, with mean duration was 6.3 months. There were 28 cases at lumbosacral region, 5 at the dorsal, and 7 at cervical region. The erythrocyte sedimentation rate (ESR) was elevated in all cases. 30 cases were tuberculous, and 10 cases were non-tuberculous. 18 cases were treated surgically, and 22 cases were treated medically. Clinical pictures respond well to either medical or surgical treatment. However, increased kyphotic deformity was reported in medically treated cases and those who had no fixation especially. Also patients who were treated nonsurgical reported residual back pain more often (55%) than patients treated surgically (17%).
Conclusions: Spontaneous spondylodiscitis (SD) is not an uncommon cause of low back pain in adults. It should be considered in any patient with acute or subacute pain with elevated acute-phase reactants. MRI is the radiological method of choice for establishing the diagnosis. Patients with SD can be successfully treated conservatively or surgically with progressive neurological manifestations.