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Question:


I have been diagnosed with spondylodiscitis .
What is the treatment for spondylodiscitis and its cause?
Antony

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.


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