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Question (06/20/2013):

Title: Spondylodiscitis caused by TB.

Hello sir, One of my friend has been affected by spondylodiscitis(caused by TB).

It has been diagnosed and his treatment (antituberculosis) follows-up for the past 1 year (accurately 15 months).

In the first MRI the Lumbar L2 bone was not visible it was fully surrounded by TB.

After 1 year (12 months) the MRI shows the L2 bone with erosion.

He is strictly using brace.

How long it takes to formed eroded bone to become normal healthy bone and how long the follow-up will go?

What type of calcium foods she must to take to make her L2 eroded bone stronger?

Waiting for reply... help me with your valuable answer.

Answer:

Thank you very much for your question.

Vertebral debridement with interbody fusion is a useful procedure for the treatment of spondylodiscitis.

Percutaneous nucleotomy and drainage (PND), less invasive procedure, is a useful next step after conservative treatment for patients in a poor condition.

The prognosis 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%.

The establishment of standard therapeutic guidelines is only possible to a limited extent.

There have not yet been any prospective randomized trials and the level of evidence for treatment recommendations does not exceed level C.

The essential 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.

There 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.

If there 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.

Conservative treatment can be considered if the clinical symptoms and destruction are relatively mild or the risk of operation appears to be too great.

The main 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.

The patient 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.

The mobilization 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.

If there is no fusion reaction, continuing destruction, or no clinical improvement, it is not promising to continue conservative treatment beyond four to six weeks.

Indications 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.

There 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 subsided.

Using 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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