Spondylodiscitis caused by TB.
sir, One of my friend has been affected by spondylodiscitis(caused
been diagnosed and his treatment (antituberculosis) follows-up for
the past 1 year (accurately 15 months).
first MRI the Lumbar L2 bone was not visible it was fully surrounded
1 year (12 months) the MRI shows the L2 bone with erosion.
strictly using brace.
it takes to formed eroded bone to become normal healthy bone and how
long the follow-up will go?
type of calcium foods she must to take to make her L2 eroded bone
for reply... help me with your valuable answer.
you very much for your question.
debridement with interbody fusion is a useful procedure for the treatment
nucleotomy and drainage (PND), less invasive procedure, is a useful
next step after conservative treatment for patients in a poor condition.
of spondylodiscitis was unfavorable before antibiotics became available.
Even today, it is potentially fatal. Current studies report that the
mean time in hospital is from 30 to 57 days and that hospital mortality
is from 2% to 17%.
of standard therapeutic guidelines is only possible to a limited extent.
have not yet been any prospective randomized trials and the level
of evidence for treatment recommendations does not exceed level C.
elements for successful treatment leading to cure of spondylodiscitis
are the fixation of the affected section of the spinal column, antibiotic
therapy, and (depending on the severity of the condition) debridement
and decompression of the spinal canal.
are no published standard guidelines for the duration of the antibiotic
therapy. It is generally recommended to administer the antibiotics
for at least two to four weeks and parenterally - as the bioavailability
is usually better then.
is a strong suspicion of tubercular spondylodiscitis, tuberculostatic
therapy can be initiated. However, the course of the disease in these
cases is mostly not particularly fulminant, so that one can wait for
the result of the pathogen diagnosis. To assure care and prevent recurrences,
the antitubercular chemotherapy should last for 18 to 24 months, although
there are no unambiguous prospective scientific data on the matter.
treatment can be considered if the clinical symptoms and destruction
are relatively mild or the risk of operation appears to be too great.
problem in conservative treatment is to achieve adequate fixation
of the affected section of the spinal column. Reclining ortheses distribute
the stress over the unaffected spinal column joints, thus decreasing
stress in the infected ventral area.
can be fully mobilized in the orthesis. If however there are major
defects in the ventral column or the lower lumbar column or the lumbosacral
border is affected, the necessary fixation can only be achieved by
at least six weeks' bed rest.
of the patient is only recommended once osseous infiltration becomes
visible. Aside from the risk of immobilization, there is a high rate
of pseudoarthroses (16% to 50%), which may eventually lead to kyphotic
malposition and chronic pain síndrome.
is no fusion reaction, continuing destruction, or no clinical improvement,
it is not promising to continue conservative treatment beyond four
to six weeks.
for emergency surgery in spondylodiscitis include losses in neurological
function and sepsis, instability, threatened or current deformities,
intraspinal space-occupying lesions, unclear etiology with possible
malignant processes, and failure of conservative therapy. Relative
OP indications are uncontrollable pain and the patient's lack of compliance
with conservative treatment.
are frequently residual symptoms after either conservative or operative
treatment of spondylodiscitis. These are due to destruction and secondary
degeneration of the neighboring segments after the inflammation has
the questionnaire Short Form 36 (SF-36), Woertgen et al. performed
a non-randomized, retrospective study of the neurological results
and the health-related quality of life on 62 patients with spondylitis
16.4 months after either conservative treatment (45%) or surgery (55%).
The authors showed that motor deficits persisted in 30% of patients
with preoperative neurological deficits, and hypesthesia in 90%.
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