spinal osteomyelitis
Introduction
Introduction to spinal osteomyelitis Spinal osteomyelitis, also known as suppurative spondylitis, is common in clinical practice, but acute cases account for only about 50%, and half of the patients are subacute or chronic. Due to different clinical manifestations, different affected parts, different symptoms and signs, they are often misdiagnosed or missed. Common pathogens are Staphylococcus aureus, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa. Source infections are more common. Secondly, spinal surgery, lumbar puncture, local open injury and other direct infections of the spine, a small number of infections adjacent to the spine, such as abscesses, hemorrhoids and so on. The patient is more common in young adults aged 20 to 40. Men are about 4 times as many as women. basic knowledge The proportion of illness: 0.001% Susceptible people: 20 to 40 years old is more common in young adults Mode of infection: non-infectious Complications: abdominal pain, sepsis, abscess, paraplegia
Cause
Cause of spinal osteomyelitis
Spinal osteomyelitis is caused by bacteremia. The primary purulent lesions are more common in genitourinary, skin and respiratory tract. In the skeletal system, the incidence of spinal infection is low, accounting for 1% to 4% of systemic bone infections. Vertebral osteomyelitis often accompanied by intervertebral disc inflammation, paravertebral soft tissue inflammation, and even paravertebral abscess, easy to spread to soft tissue is a prominent feature of vertebral osteomyelitis.
Prevention
Spinal osteomyelitis prevention
When it comes to prevention, it must start from cutting off the three sources of blood, trauma and iatrogenic infection.
In terms of blood-borne infections, prevention of general infectious diseases such as sputum, sputum, sores, sputum and upper respiratory tract infections are the most common infectious diseases, and the most common infections cause blood-borne diseases. The main measures for prevention of osteomyelitis are: keeping indoor airflow, paying attention to environmental hygiene and personal hygiene, keeping the skin clean, eating more fruits and vegetables during puberty, and using less oil to moisturize the skin to prevent sebaceous gland secretions from accumulating or Gland obstruction, usually strengthen physical exercise, enhance physical fitness, prevent colds, but also early detection and timely treatment of infection, tonsillitis repeated authors, should actively prevent and treat, if necessary, consider surgical removal.
In recent years, with the increase of traffic accidents and accidents, the number of patients with open fractures and surgical infections has increased rapidly. Therefore, active prevention should be paid attention to in daily life. Pay attention to traffic safety and labor safety to prevent skin abrasions and accidents. In case of trauma or skin abrasions, you should immediately reduce inflammation and seek medical advice.
Complication
Vertebral osteomyelitis complications Complications abdominal pain sepsis abscess paraplegia
Most of the disease may have acute abdominal pain, radiculopathy, hip pain, or severe sepsis. In some cases, inflammatory cells infiltrating paravertebral soft tissue may form paraspinal abscess, which is affected by the affected vertebral body, intervertebral disc and phase. The paravertebral soft tissue of the adjacent vertebral body is thickened, and the cross-sectional lesion is a soft tissue mass surrounding the vertebral body. The extent of the abscess involving the epidural space may cause the ventral compression of the dural sac to be curved, and the spinal cord or even the spinal cord may be involved in severe cases. Severe compression deformation, causing paraplegia.
Symptom
Vertebral myeloinflammation symptoms Common symptoms Abdominal pain Leukocytosis Hip joint pain Cold warp Spinous process tenderness High fever Spinal stiffness Straight consciousness Fuzzy map-like bone defect
In spondylitis, patients mainly present with persistent high fever, chills, fast pulse, irritability, confusion and other symptoms of systemic poisoning, localized pain, paraspinal tendon, limited spinal activity, spinous process tenderness, obvious pain and other typical diseases and The clinical manifestations are only about 20%, most of which are mainly clinical manifestations such as acute abdominal pain, radiculopathy, hip pain, or severe sepsis. After the systemic symptoms improve, local symptoms and signs tend to be obvious, and even some The case was subacute or chronic in the first place and was misdiagnosed as tuberculosis.
Examine
Examination of spinal osteomyelitis
The main methods of examination for this disease are as follows:
1, laboratory tests: early white blood cell count increased, there is obvious nuclear left shift phenomenon, increased erythrocyte sedimentation rate, blood culture may be positive, local puncture suction and biopsy under CT guidance, will extract pus for smear and bacterial culture, will The taken tissue is examined for pathology and a direct diagnosis can be made.
2. Isotope scan: In the early stage of acute suppurative spondylitis, there may be a phenomenon of isotope concentration in the spine. Although the isotope scan is a non-specific test, it is helpful to find the lesion and determine the lesion.
3, X-ray and CT examination: ordinary X-ray film within 2 weeks of onset can be found without any abnormality, tomography or CT scan, sometimes visible localized bone resorption or speckled bone destruction, with the progress of the lesion, cartilage The plate may be damaged, the edge of the vertebral body is blurred, and then the vertebrae soft tissue is swollen, the intervertebral space is narrowed, the bone density is increased, the bone is hardened, and the bone bridge is formed. When the early imaging can not make a clear diagnosis, it should be timely Diagnostic puncture under CT guidance.
Diagnosis
Diagnosis and diagnosis of spinal osteomyelitis
diagnosis:
1. There is a typical clinical and other systemic history of purulent infection.
2, clinical fever, low back pain and increased white blood cell count and other deep sputum pain.
3, MRI showed vertebral body with long T1, long T2 abnormal signal, FLAIR sequence and enhanced scan is very helpful for definite diagnosis.
4. Anti-infective treatment is effective.
Differential diagnosis
1. Spinal tuberculosis
The vertebral body and the attachment are deformed and deformed, showing a long T1 and a long T2 signal. The abnormal part of the vertebral body edge signal is blurred with the normal boundary. The intervertebral disc loses its normal shape and signal, and has different degrees of swelling, thickening or destruction, fragmentation, and intervertebral space. Different degrees of stenosis, long T1, longer T2 changes; vertebral, paravertebral soft tissue swelling, similar to muscle tissue on T1WI, higher signal on T2WI, low-signal shadow on the edge of the wire may be abscess wall; There is an abnormal contrast enhancement around the vertebral body, intervertebral disc and cold abscess. The clinical history of tuberculosis and tuberculosis poisoning.
2, spinal metastases
The diseased vertebral body showed a clear low signal on T1WI, high or equal-low signal on T2WI; intervertebral disc morphology, normal signal, no damage change; tumor easily involved in pedicle and attachment, enhanced scan, lesion vertebral body Anomalous contrast enhancement is seen inside.
3, immune discitis
It is difficult to identify spinal suppurative osteomyelitis and immune discitis by imaging method. MR examination shows vertebral destruction, the signal is long T1, long T2 changes, the disc has different degrees of swelling, thickening or destruction, fragmentation, patient temperature Elevation, the application of antibiotics is effective in the diagnosis of spinal suppurative osteomyelitis. Patients with immune discitis have no signs of bacterial infection, body temperature is generally not elevated, and antibiotic treatment is ineffective. The pathogenesis of this is the activation of collagen tissue in the intervertebral disc. The body's immune system produces delayed T-lymphocytes and cytotoxic T-cell-mediated cellular immune responses, forming antigen-antibody complexes that cause allergic inflammation, or discitis.
4, degenerative lesions
The edge of the vertebral body may have hyperplasia, T1WI at the edge of the adjacent vertebral body is low, T2WI is high signal, the boundary between the abnormal part of the vertebral body signal and the normal part is clear, the attachment is not damaged, and the degeneration of the intervertebral disc is changed: T1WI and T2WI are low. The signal, paravertebral soft tissue was normal; Gd-DTPA enhanced scanning vertebral endplate and adjacent intervertebral disc were not strengthened.
