Spondylosuppurative osteomyelitis
Introduction
Introduction to spinal suppurative osteomyelitis Spinal suppurative osteomyelitis (pyogenicosteomyelitisofvertebra) is less common, mostly caused by the cyclic transmission of Staphylococcus aureus, the primary infection lesions can be bloated, abscess and genitourinary infection, a small number of trauma, disc surgery or lumbar spine Infection caused by puncture surgery, can also be caused by soft tissue infections near the spine such as peri-renal abscess, hemorrhoids, etc., common in adults, adults in the 20 to 40 age group are common, more men than women, the incidence of lumbar spine More, followed by the thoracic vertebrae, cervical vertebrae and atlas. The lesion mainly invades the vertebral body and spreads to the intervertebral disc and the upper and lower vertebral bodies. It also invades the attachment or is attached to the attachment at the same time. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of transmission: blood transmission Complications:
Cause
Causes of spinal suppurative osteomyelitis
(1) Causes of the disease
The pathogens of this disease are most common with Staphylococcus aureus, and there are three ways for pathogens to enter the spine:
1. Spread the skin and mucous membrane purulent infection lesions through the blood route and spread them through the blood.
2. Local invasion of soft tissue infections adjacent to the spine is a direct violation.
3. Lymphatic spread spreads to the vertebral body through lymphatic drainage.
(two) pathogenesis
The disease is more common in adults, with lumbar vertebrae being the most common, followed by thoracic vertebrae. The incidence of cervical vertebrae is rare. Most of the lesions are confined to the vertebral body, spreading to the intervertebral disc and the upper and lower vertebral bodies, and occasionally diffusing into the spinal canal into the vertebral arch. Most cases are The paravertebral abscess is formed, and the lumbar vertebrae abscess is in the lumbar vertebrae. In the upper cervical vertebra, the posterior pharyngeal wall abscess is developed. The lesion develops rapidly and has sclerotic bone formation, which merges into a bone bridge and even interbody fusion.
Prevention
Spinal suppurative osteomyelitis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. Dietary attention
1. Patients with osteomyelitis emphasize and advocate a light and delicious vegetarian diet in the early stages of treatment. Factors can provide the most natural and most digestible nutrients that can be directly absorbed. If the vegetarian diet is reasonable, the three major nutrients required by the human body are sugar, fat and protein, which are sufficient for the reasonable needs of the human body. Because of the repair of bone and soft tissue, vitamins, trace elements and macro elements and protective plant hormones and fiber are inseparable. Vegetarians contain the most abundant alkaline substances, such as the most active calcium and potassium ions in the body, and the content of fruits is high.
2, avoid eating a lot of meat, eat less fruits and vegetables.
Complication
Spinal suppurative osteomyelitis complications Complications
Some cases can be complicated by limb paralysis.
Symptom
Spinal suppurative myeloinflammation symptoms common symptoms high fever back pain low back pain chills low heat osteosclerosis toxemia chills bedridden
1. Acute type: This type usually comes from the blood route, the patient has a sudden onset of illness, chills, chills and high fever, body temperature can reach 40 ° C, symptoms of toxemia are obvious, low back pain or neck and back pain is obvious. Bedridden, can not turn over or turn neck, paravertebral muscles are obvious, and there is sputum pain, blood white blood cell count is significantly increased, up to tens of thousands, neutrophils account for more than 80%, and poisoning particles, blood culture Pathogenic bacteria can be detected, high fever can last for more than 2 weeks, and some cases have limb paralysis. Large psoas abscess can be touched at the waist or when flowing to the thigh. In early cases, X-ray examination of such cases is often found without abnormalities, at least After 1 month, the worm-like damage occurred in the vertebral body. Once the X-ray signs appeared, the bone destruction developed rapidly, the shape of the vertebral body was asymmetrical, and the wedge shape changed. The density became thick and white, and it spread to the adjacent vertebral body. The intervertebral space is narrowed, and paravertebral abscess can be seen. Finally, bone fusion or interbody fusion is formed. CT and MRI examination can detect vertebral destruction and paraspinal abscess in advance.
2. Subacute type: These cases usually have a history of intra-abdominal inflammation or intra-abdominal infection in the near future, and low back pain and fever occur shortly after discharge from the control of infected lesions or suppurative appendicitis. The body temperature is generally not exceeded. At 39 °C, the symptoms of toxemia are also mild, with increased white blood cell count and accelerated blood cell sedimentation rate. The pathological changes of this disease occur at the edge of the vertebral body. Therefore, early X-ray examination often has no positive findings, and X-ray findings are often delayed. After 1 to 2 months, it appears as vertebral marginal destruction and narrowing of intervertebral space and progressive osteosclerosis. The pathogenic bacteria in these cases are mostly less toxic, or the patient's body resistance is stronger, so the whole The course of the disease manifests itself as a benign process.
3. Chronic type: Insidious onset, patients have low back pain unconsciously, no nerve root symptoms, low body temperature, or only low fever, like tuberculosis, blood white blood cell count is not high, but blood cell sedimentation rate can be increased Fast, early X-ray examination often has no positive findings. After 1 to 2 months, the vertebral body is diagonal, and half of the vertebral body density is increased, and bone sclerosis appears. As the lesion progresses, the intervertebral space progressively narrows. It usually takes half a year. If the patient is older, it is often diagnosed as metastatic sclerosing bone tumor. After using antibiotics, the symptoms will improve, but it will recur, so the whole course of disease is a chronic protracted course.
Examine
Examination of spinal suppurative osteomyelitis
Blood routine examination showed a significant increase in white blood cells, elevated neutrophils, positive blood culture and increased erythrocyte sedimentation rate.
Radionuclide imaging: MRI is helpful for early diagnosis. There is no bone change in the early stage of X-ray examination, but it can be compared with X-ray changes after one week.
Diagnosis
Diagnosis and diagnosis of spinal suppurative osteomyelitis
Diagnostic criteria
1. Acute type: rapid onset, high fever and toxemia symptoms, blood culture can often detect pathogenic bacteria, early detection of lesions depends on radionuclide bone imaging, and MRI examination helps early diagnosis, can be expressed An inflammatory abnormal signal and bone destruction.
2. Subacute type: If you have a history of intra-abdominal inflammatory disease or a history of infection after intra-abdominal surgery, you can remind the diagnosis.
Differential diagnosis
The disease must also be differentiated from spinal tuberculosis. Some children may have high fever when they have vertebral tuberculosis. The vertebral body is broken into a wedge shape and there is paraspinal abscess formation. However, tuberculous lesions do not show bone sclerosis, and the X-ray findings progress. It is also slow, and the disease must be differentiated from spinal tumors with cancerous fever. The disease is mostly confined to the vertebral body and rarely spread to the attachment; while the spinal tumor invades the pedicle early, it can be identified.
Those without such a history are often confused with adult intervertebral disc type spinal tuberculosis, but the manifestation of osteosclerosis is helpful for diagnosis. This disease is difficult to distinguish from intervertebral space infection. Some people think that this type is a type of intervertebral space infection.
Confused with sclerosing spinal tumors, especially older people are more difficult to distinguish from prostate cancer bone metastasis. According to the complete pedicle and progressive intervertebral space narrowing, the diagnosis is not difficult, because the imaging basis is late, it is difficult to make Early diagnosis, so some cases require bone tissue biopsy.
