Answer:
Dear
Antony,
It is
very difficult to diagnose spondylodiscitis at the first medical examination.
The main
causative organism use to be Staphylococcus aureus.
Bacterial
spondylodiscitis (vertebral osteomyelitis) is an infection of the
intervertebral disc and the adjacent vertebral bodies.
It usually
starts at the interface (a surface forming a common boundary of two
bodies, spaces, or phases)of the disc and the vertebra.
Infection
follows the hematogenous route from a distant site such as urinary
tract infection, prostatitis, endocarditis, intravenous drug use,
and cutaneous infection, including furunculosis.
Most
common symptoms are back pain and fever.
Neurologic
manifestations of paraparesia, paraplegia, and meningitis can be found,
usually secondary to Staphylococcus aureus or Mycobacterium tuberculosis.
Spinal
infections are uncommon, accounting for only 2% to 4% of all osteomyelitis
infections.
The most
common method of spinal infection is through the arterial spread of
pyogenic bacteria.
Spondylodiscitis
requires immediate debridement of the focus, with decompression and
stabilization through a ventral approach, when conservative management
fails. Otherwise, severe complications occur, such as sepsis, vertebral
body destruction, abscess, or neurological deficits.
In the
past, antibiotic drugs were the standard (and only) method of treatment
for spinal infections. With the advances in modern neurosurgical techniques
for spinal instrumentation and fusion, use of these techniques should
be reevaluated.
Surgical
treatment is the modality of choice in patients with acute spinal
osteomyelitis. It is especially indicated in patients with progressive
or severe neurological deficits and spinal deformity.
In experienced
hands, surgery is safe and offers the advantages of spinal cord decompression,
immediate mobilization, and correction of spinal deformity. The decision
whether an anterior or posterior approach should be used must be made
on an individual basis.
