intervertebral space infection
Introduction
Introduction to intervertebral space infection Suppurative spondylitis is relatively rare, there are two types of clinical, one is vertebral suppurative osteomyelitis, and the other is intervertebral space infection. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: paraplegia
Cause
Cause of intervertebral space infection
(1) Causes of the disease
The pathogens of intervertebral space infection are most common with Staphylococcus aureus and Staphylococcus aureus.
(two) pathogenesis
There are two ways in which bacteria enter the intervertebral space:
1. Contaminated surgical instruments are directly brought into the intervertebral space. The most common infection in the past is the infection after intervertebral disc surgery, the incidence rate is between 0.1% and 0.5%. In recent years, percutaneous discectomy and endoscopic discectomy Prevailing, once the device is not strictly disinfected, intervertebral space infection can also occur, so the total number of cases has increased.
2. It is generally considered that there is no blood supply to the adult intervertebral disc through the blood channel, but some people think that there is sufficient blood supply under the age of 30, and even that there is still blood supply to the old age, and from the adjacent vertebral body with the increase of age. The blood supply through the vertebral body plate into the nucleus pulposus gradually decreases, but sufficient collateral circulation can still be obtained from the surrounding blood vessels. Therefore, the source of the disc infection can be considered to be similar to the source of the vertebral body infection, and the primary lesions mostly come from the skin. Mucosa or urinary tract may be caused by reflux of the Batson's venous plexus. It has been reported to occur after catheterization and to obtain positive blood culture, with infection from the urinary tract being the most common.
Prevention
Intervertebral space infection prevention
Strict operation should be strictly observed during surgery. If infection occurs in other parts of the body, treat it as soon as possible to avoid spreading.
Complication
Intervertebral space infection complications Complications
The most serious complication is paraplegia.
Symptom
Symptoms of intervertebral space infection Common symptoms Nerve root stimulation Lumbar back pain, back pain, severe pain, lumbar muscle spasm, neuralgia, high fever, chill, loss of appetite
The infection of the intervertebral space caused by surgical contamination is slow or slow, or the infection caused by hemolytic Staphylococcus aureus is often acute, with chills and high fever, increased back pain, and obvious nerve root stimulation. Symptoms, patients do not dare to turn over due to severe pain, slight vibration can trigger convulsions and cause screams, signs of lumbar muscle spasm and tenderness, movement disorders, the original nerve root stimulation signs are aggravated, do straight legs In the elevation test, even the heel is difficult to leave the bed surface, and the patient often refuses to perform any examination because of the severe pain. The infection caused by the less toxic bacteria, such as Staphylococcus aureus, is slow, and the systemic symptoms and signs are compared. Lighter, the course of the disease tends to be chronic.
Blood-borne intervertebral space infections are generally seen in young adults, children are rare, the incidence of lumbar vertebrae is high, general onset is slow, fever, loss of appetite and other symptoms, lumbar spine lesions have low back pain and sciatica, signs There are tenderness, psoriasis and movement disorder. After plaster and antibiotic treatment, the symptoms can be relieved. Once the activity is too much or the treatment is stopped, the symptoms are aggravated and the course of the disease tends to be chronic. The white blood cell count increases during the fever period, but the blood cell sedimentation rate continues to increase. Quickly indicate that the lesion is still active.
The most serious complication is paraplegia. Kemp reported a group of cases with a paraplegia rate as high as 40%, with 1/2 of the cases combined with diabetes.
Examine
Examination of intervertebral space infection
Blood routinely showed an increase in white blood cell count and increased erythrocyte sedimentation rate.
Radionuclide bone imaging and MRI examination can detect lesions early, and two corresponding vertebral bodies in the intervertebral space of the lesion have symmetrical inflammatory abnormal shadows on the MRI slice.
The X-ray findings of intervertebral space infection appear only as late as one month after the onset of the disease, and can be divided into four stages:
1. The first stage of the intervertebral space is narrowed, occurring within 3 months of the onset of the disease.
2. The second stage begins after 3 months of onset, manifested as progressive hardening of the subchondral bone, increased density of adjacent vertebral bodies, and particularly prominent on the lateral position, which is due to the formation of new bone under the periosteum.
3. In the third stage, the adjacent vertebral body plate was progressively irregular, and the vertebral body edge showed reactive sclerosis, indicating the progression of inflammation.
4. The fourth stage of the intervertebral space showed a balloon-like change, accompanied by vertebral erosion, and the density of the vertebral body was still visible.
Diagnosis
Diagnosis and diagnosis of intervertebral space infection
The diagnosis of intervertebral space infection is relatively late, especially the diagnosis of blood-borne disc infection is later, the shortest is 3 months, and the longest is diagnosed 18 months after the onset, which is almost the same as suppurative vertebral osteomyelitis. Three times later, MRI examination can detect lesions early, and two corresponding vertebral bodies in the intervertebral space of the lesion have symmetrical inflammatory abnormal shadows on the MRI slice.
Generally not confused with other diseases.
