Hematogenous osteomyelitis of the spine. Spinal osteomyelitis: causes, symptoms, treatment and consequences, photos. Spinal spondylitis

Spinal osteomyelitis is one of the rarest and most dangerous pathologies musculoskeletal system. In some cases, this insidious disease is almost asymptomatic for many months, slowly eroding a vital organ from the inside. Meanwhile, it is the timely detection of osteomyelitis of the spinal column that makes it possible to successfully cope with the pathology and prevent the sad consequences of the disorder. How to identify and treat a dangerous disease?

What causes the disease?

Spinal osteomyelitis, also known as spondylitis, is an infectious disease accompanied by the formation of purulent foci in bone tissue. The causes of the pathology are associated with the penetration of pyogenic microorganisms into the spinal column.

In the vast majority of cases, the source of inflammation is Staphylococcus aureus; less commonly, the disease is provoked by streptococci, Pseudomonas aeruginosa and Escherichia coli, and Mycobacterium tuberculosis.

It must be taken into account that healthy bone tissue is highly resistant to the penetration of pathogenic microorganisms, therefore spinal osteomyelitis develops only in the presence of certain risk factors. These include:

injuries and operations on the spinal column and internal organs;
immunodeficiency states;
infectious diseases;
deep carious lesions of teeth;
intravenous drug administration with unsterile needles;
disorders of the circulatory system;
purulent inflammation of soft tissues;
diabetes;
invasive medical procedures performed without sterility.

It has been noticed that older people suffer from osteomyelitis of the spine much more often, since the body’s resistance to the effects of pathogenic bacteria deteriorates over the years. In addition, the condition of the urinary system plays a huge role: more than half of all cases of purulent spondylitis begin with inflammation of the lumbar spine, where the infection penetrates through the urinary ducts. With absence proper treatment the disease can spread to other parts of the spinal column.

How does the disease manifest itself?

There are 2 variants of the course of spinal osteomyelitis - acute and chronic. Unlike many other diseases, chronic purulent spondylitis does not always result from acute infectious inflammation; it can also develop as an independent form. Depending on the characteristics of the pathology, symptoms may vary. In acute osteomyelitis, the signs are most often pronounced:

the patient experiences sharp back pain, worsening at night;
suffers from sweating;
temperature increase to 39–39.5 °C;
hypotension;
convulsions;
the inflammatory process causes swelling and discomfort in the soft tissues surrounding the spine.

In some cases, vertebral osteomyelitis develops in a sluggish form and is accompanied by a long low-grade fever, mild pain, while it is impossible to clearly determine their localization. Chronic spondylitis is characterized by similar symptoms.

Often, sluggish forms of the disease are confused with other pathologies of the musculoskeletal system and internal organs. It must be remembered that osteomyelitis affects not only bone tissue, but also the vertebral blood supply system, which is fraught with the most serious consequences, including disability and death.

Therefore, in case of back pain of unknown etiology, it is necessary to consult a specialist and determine the cause of the ailment in order to detect a possible pathology at the first stage.

Diagnostic measures

As mentioned above, early detection of osteomyelitis of the spinal column significantly increases the opportunity to cure the disease without serious consequences for the body. Modern highly effective diagnostic methods for this pathology make it easy to establish an accurate diagnosis. For this use:

radiography;
computed tomography;
radionuclide research;
fistulography.

Most of the listed methods involve obtaining a photo in which the affected area is clearly visible, thanks to which it is possible to identify the features of the inflammatory process. To compile a complete picture of the disease and determine the best treatment regimen, the patient is also prescribed various tests, the material for which is not only blood, but also the contents of the lesions.

Methods of therapy

Patients with spinal osteomyelitis who promptly seek medical help are most often prescribed conservative treatment, but it must be taken into account that complete elimination of all symptoms of the disease and subsequent recovery takes more than one month.

A prerequisite for successful therapy is the use of antibacterial drugs, selected individually. The duration of antibiotic treatment can be up to 4 weeks or more, depending on the severity of the disease and the body's response to medications.

At the same time, the patient is prescribed detoxification procedures, painkillers and immunomodulatory drugs, prolonged bed rest and fixation of the back and neck with special corsets to prevent deformation of the spinal column.

In particularly severe cases (multiple purulent foci, fistulas, neurological disorders due to osteomyelitis), as well as in the absence of results from conservative treatment, the patient is indicated for surgical intervention. During the operation, purulent cavities are sanitized and the wound is further drained. If necessary, grafts are installed in place of damaged and destroyed vertebrae.

As soon as complete recovery from spinal osteomyelitis occurs, the patient can begin restorative procedures. Rehabilitation includes physical therapy and special health-improving exercises to restore normal mobility of the spinal column and reduce discomfort.

With a favorable outcome of treatment, the inflammatory process goes away completely, and the affected bone areas grow together, preventing spinal deformation.

Spinal osteomyelitis is a disease in which inflammation begins inside the vertebrae and purulent accumulations form. The reason lies in the fact that bacteria, the causative agents of infection, infect bone tissue. Symptoms include severe pain in the area where osteomyelitis occurs and a sharp increase in body temperature. Surgery can be avoided if started as early as possible drug treatment osteomyelitis.

Osteomyelitis vertebrae can affect a person's spine for several reasons. One of the main ones is older years. And many other factors that make the human body weaker - traumatic effects, various diseases and pathological processes. All this increases the likelihood that osteomyelitis will affect the patient's spine.

The impetus for the disease is usually the penetration of infection into soft tissues through blood and mechanical damage to the vertebral bodies and the cartilage between them. The older a person is, the higher the likelihood that osteomyelitis will overtake him. Patients are usually over fifty years of age. In more than half of the situations, the process initially affects only the lower back, and then spreads. The pathogen enters from the urinary outflow through the veins.

Cardiac problems may be another risk factor. The infection sometimes enters through ordinary ulcers, diseased teeth or inflammation of the ears. A large number of bacterial infections can lead to the development of the disease. After traumatic effects or surgical intervention, the pathogen can enter the vertebral bodies through prostheses. Sometimes this happens due to the use of non-sterile devices - syringes and catheters. Therefore, drug addiction becomes another reason.

Development and symptoms of osteomyelitis

Osteomyelitis is a type of spondylitis. This is the name of a group of diseases in which human bone becomes softer and festers. The pathological process is triggered by streptococcus aureus, E. coli, and actinomycetes. To explain how infection occurs, let us recall the circulatory system of the spine.

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The body of each vertebra is isolated, separated from the others by intervertebral cartilage and end plates. Along the ridge line in the neck there are two arteries that branch into several streams. In the chest area, blood circulates through the soft paravertebral tissues through the arteries between the ribs. The lumbosacral region receives nutrients through the arteries of the lower back and sacrum. Arterial branches are fixed in a network inside the bone tissue. The vertebra is surrounded everywhere by small venous vessels, which collect into larger veins.

The causative agents of osteomyelitis can enter bone tissue through both venous and arterial blood. When they get there, the human immune system activates inflammation. But during this fight with the enemy, bone tissue also dies.

Dead microorganisms create pus accumulations inside the vertebrae. Sooner or later it comes to the point that the pus destroys the lining of the vertebra, moving towards the end plates. Thus, the purulent process reaches the nearby vertebrae. In relation to the infective power of pathogenic microorganisms, the following types of spinal osteomyelitis are distinguished:

Acute (half of all statistics);
Chronic (quarter);
Primary chronicle (about ten percent.

Elderly men usually fall victim to this disease. Tension and stress a large number of various other diseases leads to weakened immunity. As a result, the body has a harder time fighting off hostile bacteria and controlling inflammation.

The most common is the acute type. Symptoms primarily include severe pain in the infected area. In this case, fever, fever, increased sweating, and weakness are observed. Swelling of the soft tissues of the spine appears, the blood vessels become excessively tense (which can lead to the formation of blood clots), and the spinal muscles hurt. Symptoms of the chronic form are less pronounced. The pain syndrome is dull in nature, the temperature rises slightly and remains at this level for a long time. The pain is difficult to localize, symptoms resemble pneumonia or kidney inflammation. Some patients are even sure that they are suffering from ordinary osteochondrosis.

Severe pain is usually caused by pressure inside the vertebral bodies. If the integrity of the abscess is broken not towards the end plate, but outside the spine, abscesses appear.

Another problem is that the body builds up bone tissue to replace damaged tissue. When cracks facing towards the spinal cord heal, it may end up with too much hard tissue healing and they begin to put pressure on the spinal cord. Which will cause a large number of serious neurological symptoms.

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When the disease becomes chronic, there are more and more abscesses inside the bone, and each of them grows on its own. When new bone tissue grows instead of pus, it may not be compatible with the surrounding bone walls. As a result, these areas can easily become infected again.

The bone marrow is also exposed to infection. Pus prevents new blood cells from developing normally. First of all, the immune system suffers.

Diagnostic methods

The acute period begins a few days after the pathogen has penetrated the vertebrae. Inflammation and purulent process trigger pain and high fever. When diagnosing spinal osteomyelitis, you must first understand which microorganisms caused it. For this purpose, bacteriological analysis and various photographs of the inside of the vertebrae are used. Based on the data, an approximate prognosis for the development of inflammation is drawn up and a treatment plan for the patient is outlined.

Diagnostic methods for finding different types diseases do not differ:

X-ray examination is most often used to find purulent cavities in the vertebral bone. X-rays help best if the osteomyelitis is chronic;
Tomography on a computer gives similar data, but best quality. The localization of pus and new bone tissue is more accurately determined;
MRI allows you to recreate detailed images of ulcers and cavities, obtain data on whether the marrow is affected by the bones;
Ultrasound makes it possible to find abscesses in the soft tissues of the spine.

To understand the state of the patient’s immune system with osteomyelitis, a blood test is used to determine the number of leukocytes and the erythrocyte sedimentation rate. A radical diagnostic method is the analysis of the purulent accumulations themselves.

Treatment of osteomyelitis

Infectious and bacterial deformities of the vertebrae are treated comprehensively. If there are no indications, doctors usually try to limit themselves to conservative treatment of inflammation. First of all, you need to fight the causative agent of osteomyelitis itself and strengthen the immune system. This includes the use of general strengthening medications. The period of conservative treatment ranges from a month to two, if the pathology was not diagnosed at an advanced stage. Antibiotics are mainly used to fight bacteria.

Surgeon intervention for osteomyelitis will be required if the membranes of the vertebrae or intervertebral discs are too damaged. You cannot perform surgery if the infection has entered the blood and internal organs. Conservative therapeutic methods will also have to be used if inflammation causes other complications.

To effectively recreate the original structure of the vertebra after osteomyelitis, bone transplantation is used from the patient’s own ribs.

Treatment is often quite difficult: the implant does not always take root well, and the healing process is often very painful. Blood circulation in the vertebra may be disrupted, swelling of the paravertebral tissue may appear, and the sensitivity and mobility of the operated area may become worse. Sometimes it happens that the transplanted tissue suddenly breaks down, causing a change in the position of the vertebra.

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In many cases, instead of transplanting the patient's own bone, doctors prefer to strengthen the bone with titanium fixing parts.

And using modern materials, you can fill them with antibiotics and other medications that slowly act on the diseased area. Such a material is, for example, a porous titanium alloy. The earlier the patient began treatment for osteomyelitis, the higher the likelihood that it would be successful. Lethal outcome is possible only if the infection affects internal organs, especially the lungs and heart.

Spinal diseases are divided into two groups: those caused by viral and bacterial infections, and those caused by genetic disorders and natural aging processes. Infectious pathologies are rare, but the consequences of the disease can be dangerous. Spinal osteomyelitis, or hematogenous purulent spondylitis, the most dangerous of infectious diseases, since damage is caused to the hematopoietic and musculoskeletal systems. The pathology is systemic in nature. In 2% of cases, focal lesions of the spine and other parts of the skeleton occur. If the disease develops covertly, large-scale destruction of bone tissue may occur.

Causes of occurrence and development

The occurrence of infectious diseases of the musculoskeletal system (OSA) can be triggered by certain factors; the likelihood of pathology increases with age. It most often occurs after 45-50 years. This is explained by the fact that the body at this age is weakened by other diseases.

With spondylitis, infection can spread to the spine different ways. Destruction of the vertebrae occurs due to injury, and infection enters the intervertebral discs, cracks in bone tissue. The infection can penetrate through the vessels that feed the vertebral bodies.

More than 50% of cases of pathology begin in the lumbar region; the vertebrae of the lower back, located next to the excretory system, are the first to suffer. From the urinary tract, the infection penetrates through the prostatic venous plexus.

Pathologies of the cardiovascular system and soft tissues can also be a source of damage. Bacteria can penetrate through the blood from an inflamed inner ear, an inflamed tooth, or from furunculosis. Spinal osteomyelitis occurs due to the spread of infection as a result of pneumonia, prostatitis, salmonellosis, measles, scarlet fever.

Non-hematogenous osteomyelitis can occur after spinal surgery due to weakened immunity, damage to bone and soft tissue. Infection can enter the spine through implants, biotechnological prostheses, around which blood circulation is very intense, and active formation of bone tissue.

Sometimes an infection can occur due to unsterile equipment: syringes, venous catheters. Risk factors include people with drug addiction, alcohol abuse and smoking.

Summarizing the above, we can say that the reasons for the development of the disease are as follows.

1. Infectious lesions of the elbow, knee and other joints can lead to osteomyelitis of the spine. The location of the source of infection does not matter, because the infection is transmitted through the bloodstream or hematogenously.

2 The infectious focus can serve as a source of infection of the bone tissue of the spine. Sore throat, caries, furunculosis, phlegmon in the area of any joint create a risk of transmitting an infectious pathogen.

3. Injuries. The risk of developing osteomyelitis increases due to a gunshot wound, deep fractures, and spinal surgery.

4. Infectious diseases. Tissue damage occurs due to bone tuberculosis, late stage syphilis. Characterized by multiple bone lesions: hip, knee joints.

Symptoms of the disease

Various types of bacteria are recognized as causative agents of osteomyelitis:

gram-negative bacteria: Pseudomonas aeruginosa, Escherichia coli, Proteus.
gram-positive bacteria: in 50% of cases, this is streptococcus aureus.
pathogenic representatives: causative agents of leprosy, tuberculosis, mycobacteriosis.

Bacteria enter bone tissue through arterial or venous blood. As soon as this happens, the human immune system activates resistance to this, but the bone tissue dies. Microorganisms inside the vertebrae create purulent accumulations. Gradually it comes to the point that the pus destroys the outer layer, moving towards the end plates. Nearby vertebrae are also affected.

Depending on the strength of infection and the development of the disease, osteomyelitis occurs:

Acute, occurs in 50% of cases.
Chronic (25 - 35%).
Primary chronic (about 15%).

According to statistics, the disease most often affects men over 40 years of age. This is facilitated by weakened immunity, poor health, autoimmune diseases, and diabetes.

Spinal osteomyelitis is considered to be an aggressive disease, since its acute form is more common than its chronic form. The symptoms are severe and include acute pain in the affected area. The patient may complain of weakness, increased sweating, fever, fever. The pain spreads to the back, the blood vessels become tense, which leads to the formation of blood clots, and swelling of the soft tissues of the spine appears.

Symptoms of the chronic form are not so pronounced. The pain is dull in nature, the temperature remains at a fairly high level for a long time. Signs resemble pneumonia or kidney disease. Some believe that they have severe osteochondrosis. The pain syndrome is explained by pressure inside the vertebral bodies. Abscesses may appear if the abscess breaks outside the spine.

The body begins to build up bone tissue, replacing the damaged one. The cracks facing the spinal cord begin to heal, there are more and more hard tissues, they begin to put pressure on the spinal cord. Neurological symptoms may indicate this.

Lumbar spondylitis

Osteomyelitis of the lumbar spine is one of the most common ailments today. The infection enters the bone region through the veins of the lumbar region. It almost never occurs in healthy people with strong immune systems. The risk group includes people suffering from oncology, AIDS, drug addiction, disabled people, and people who have undergone organ transplantation.

The main symptoms of disease in this part of the spine are heat and severe pain. At the same time, at the initial stage of the inflammatory process, no unpleasant sensations arise, then the pathology progresses, the pain syndrome becomes stronger, especially at night.

Cervical spondylitis

Osteomyelitis of the cervical spine is rare. Pain in this disease is localized in the neck area. Otherwise, the causes and signs of the disease correspond to the symptoms manifested in osteomyelitis of other parts.

Diagnosis of the disease

The main task of diagnosis in the acute form is to identify the type of bacteria that caused the infection. To do this, bacteriological studies are carried out to help determine the routes of infection.

To determine the chronic form of the disease, bacteriological studies are carried out in conjunction with differential diagnosis. The most popular and effective diagnostic methods are:

Magnetic resonance imaging will be able to show the condition of the soft tissues and whether there is any accumulation of fluid. Imaging abscesses is very important to guide proper treatment.

Computed tomography provides high-quality images in several projections. It shows fistula tracts and newly formed tissues.

Ultrasound examination helps to identify abscesses in all areas.

Scintigraphy gives a complete picture 24 hours after the onset of the inflammatory process.

All images can provide information about the nature of changes in bone tissue. But the resolution of the images is not sufficient to clearly determine the boundaries of the affected area. Therefore, the following examinations are carried out:

Immunoscintigraphy shows the exact location of inflammation.

Positron emission tomography, in combination with computed tomography, provides an accurate 3D image of the lesion. This study is effective at an early stage of the disease.

Treatment methods for osteomyelitis

Treatment of osteomyelitis requires integrated approach. It includes:

drug therapy;
physiotherapeutic procedures;
surgical intervention.

Drug treatment

Conservative treatment includes:

detoxification;
taking antibiotics;
taking non-steroidal anti-inflammatory drugs.

In case of acute osteomyelitis, the patient is recommended to rest in bed. The best thing is to be on a special bed that ensures the correct position of the body. Bed rest is indicated for 90 days. Such a long period is necessary to normalize the ESR and relieve inflammation.

Most often, spinal osteomyelitis develops against the background of another infectious disease; its treatment should be carried out in parallel. Antibiotic treatment is mandatory in the treatment of this complex disease. Penicillin is prescribed to control the spread of pathology. If you start treatment in the first days, you can immediately stop the pathological destruction of bone tissue. In the second week of illness, the effectiveness of antibiotic treatment decreases. It is necessary to monitor the results of therapy using clinical tests.

Spinal deformity may occur in 30% of patients, so external immobilization is indicated to prevent deformation and stabilize the spine. When treating osteomyelitis of the cervical spine, external immobilization is performed using a special collar or traction. If the disease affects other parts of the spine, these measures are not necessary.

In the acute form of hematogenous osteomyelitis, local treatment is used, sorbents, anti-inflammatory ointments are applied to the affected area, and proteolytic enzymes are used. At the same time, intensive detoxification therapy is carried out. Intravenous infusions of saline, rheopolyglucin and other agents are given. Therapy includes the introduction of specific serums to enhance immunity.

Physiotherapy

Physiotherapeutic procedures are necessary:

to eliminate the inflammatory process;
to accelerate the formation of sequestration;
to activate recovery processes;
to stimulate the immune system;
to reduce the body's sensitivity to the effects of bacteria.

If there is a path for the outflow of the fistula and a decrease in the inflammatory process, in combination with systemic antibiotic therapy, the following is prescribed:

3. SUV irradiation

4. Infrared therapy

To improve healing processes, the following are effective:

for chronic osteomyelitis in the remission phase, calcium chloride electrophoresis;
electrophoresis with drugs aimed at improving metabolism, vitamins;
ultrasound therapy;
peloidotherapy;
applications of paraffin and ozokerite;
high frequency magnetic therapy.

Electrophoresis of vasodilators is used to dilate blood vessels in the lesion.

Improve metabolic processes flowing in connective tissue will be able to:

peloidotherapy, it is carried out in the remission phase in the form of applications;
radon and hydrogen sulfide baths;
electrical stimulation, electrodes are placed at the exit of the nerves;
ultrasound therapy, it stimulates collagen synthesis;

In the absence of purulent contents, low-frequency magnetic therapy is used in the remission phase, designed to reduce the activity of the blood coagulation system.

To activate the immune system the following is prescribed:

SUV irradiation;
laser irradiation of blood;
high-frequency magnetic therapy;
electrophoresis of immunomodulatory drugs;
heliotherapy.

Oxygen barotherapy and ozone baths improve the supply of oxygen to affected tissues.

Contraindications to physiotherapy

septicopyemia;
abscesses in the absence of a path for the outflow of pus;
high body temperature;
severe intoxication.

Surgical intervention

The operation is prescribed to open paravertebral or epidural spinal abscesses. During surgery, antimicrobial therapy is an important adjunct. The surgeon’s task is to remove all necrotic areas of tissue and bone, eliminating dead spaces. They form around the lesion; they can be closed in the following ways:

transplant skin onto the granulating surface of the bone;
fill the cavity with looped bone grafts;
expose the wound, allowing for a slow granulation process.

Sequestrectomy includes four points:

1. The focus of necrotic tissue, pus, and sequestration is removed from the osteomyelitic lesion.

2. The sclerotic wall of the sequestral capsule is removed until blood-supplied areas of the bone appear.

3. The bone marrow canal is opened, its lumen is revealed.

4. The residual cavity is treated and plastic surgery is performed using a muscle flap.

It is possible to achieve good results during surgery only if the acute phenomena in the tissues and bones have already subsided.

After the operation, you need to undergo rehabilitation; the period can be quite long.

Spa treatment

In the recovery stage of acute osteomyelitis or in the chronic form in remission, it is useful to stay in sanatoriums with balneo- and climate-therapeutic effects. In our country there are such sanatoriums in Sochi and Pyatigorsk. In case of chronic osteomyelitis with large sequesters, sanatorium-resort treatment is contraindicated.

Prognosis for osteomyelitis

Recovery directly depends on the characteristics of the immune system, age and neglect of the process. Restoration of function of the affected limb and recovery depends on the treatment provided. The result is considered good if after surgery there is no relapse of the disease for three years. According to medical statistics, in 70% of cases the effect is positive.

The duration of disability is 12 months, depending on the speed of closure of the defects and the extent of inflammation. If the functions of the musculoskeletal system are impaired, an examination is carried out to assign a disability group.

Self-medication in case of osteomyelitis is unacceptable. It is impossible to achieve a cure without high-quality sanitation of the infected source of inflammation.

Possible complications

The most dangerous complication is blood poisoning, or sepsis. The infection spreads throughout the body, depositing in various tissues and organs. The following complications may also occur:

ankylosis, leading to joint immobility;
phlegmon, soft tissues are saturated with pus;
abscess, accumulation of pus;
spontaneously occurring fractures;
purulent arthritis;
contracture, immobility of the limbs due to scar adhesions in the muscles.

Spinal osteomyelitis is an infectious and inflammatory disease of bone tissue, the cause of which is considered to be infection by pathogenic microorganisms. Infection occurs in various ways; elderly people and patients who have previously suffered a spinal injury are at risk.

Causes

Osteomyelitis has several causes, but it always develops against the background of infection with pathogens that enter the bone tissue in various ways.

Factors in the development of the disease include:

Weak immunity.
The presence of a source of infection in the body.
Previously received spinal injury.
Poorly performed surgical intervention.

Infection occurs if the human body is weakened and cannot resist infectious agents. They enter the body through the bloodstream or are already present in it if a person has a chronic disease, penetrating into the vertebrae.

Pathogenic microorganisms settle on bone tissue, causing an inflammatory process. Leukocytes (the body's defenders) are sent to the site of inflammation. In the fight against bacteria, leukocytes die, and purulent masses accumulate in the spinal cavity. This affects the condition of the bone tissue, it softens and becomes fragile.

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Inflammation can be a consequence of injury or damage, but provided that the injury has not been healed and pathogenic bacteria have entered the vertebral cavity.

Possible causative agents of osteomyelitis:

coli;
Staphylococcus aureus.

These bacteria can enter the body in various ways. They often penetrate into the bloodstream during surgical interventions or when non-sterile instruments or dressing materials are used. But weakened immunity plays a decisive role. The body cannot produce antibodies in the required volume, which stop the inflammatory process and prevent it from developing.

Who is at risk:

Elderly people over 50 years old.
Persons who use drugs.
People who have had spinal injuries or surgery.
Patients diagnosed with HIV or AIDS.

Description of symptoms

Signs of the disease are pronounced, especially if we're talking about about acute osteomyelitis. In this case, the person experiences:

sharp pain in the lumbar region;
significant increase in body temperature;
severe intoxication of the body;
decreased mobility;
nausea, vomiting, lack of appetite.

Since the disease occurs against the background of infection by pathogenic microorganisms, all the main signs of infection are present. The process develops rapidly and can soon cause serious complications.

The first thing you should pay attention to is the appearance of pain in the lumbar region, although another part of the spine may be affected. For this reason, pain is observed in a specific place; with palpation or movement, the pain intensifies.

The general well-being of the patient also changes. The person becomes lethargic, apathetic, and refuses to eat. If help is not provided at this point, the bacterial infection can cause death.

Diagnosis of osteomyelitis

Depending on the symptoms, treatment for spinal osteomyelitis is prescribed. To make an accurate diagnosis, a number of procedures will be required:

Donate blood for analysis (bacterial culture, ESR).
Take an x-ray of the spine in various projections.
Ultrasound examination of the spine.

It is permissible to carry out other diagnostic procedures:

MRI of the spine allows you to obtain accurate information about the locations of bone tissue damage;
A CT scan of the spine is more informative than an X-ray, but gives a less clear “picture” than an MRI;
endoscopic examination allows you to obtain maximum information about the location of inflammation and the degree of damage to bone tissue and vertebrae.

An endoscopic examination is carried out both with and without the collection of biological material for analysis. The puncture is performed only in the presence of acute indications. Diagnostics allows not only to differentiate the disease, but also to determine the degree of damage to internal organs, as well as the speed of the body’s response to the inflammatory process.

Treatment of osteomyelitis

Therapy takes place in several stages and directly depends on the severity of the inflammatory process and the duration of its course. If other organs are not involved in the pathological process, then conservative treatment is acceptable.

The treatment process takes several months and can proceed with varying degrees of success. A long course will help you get rid of the disease completely. Mostly, antibiotics are administered intravenously, but intramuscular administration of drugs is acceptable. If conservative therapy is powerless or the inflammation has spread to internal organs and tissues, then the question of surgery is raised.

Attention! Therapy is reduced to taking antibiotics wide range actions. The drugs are toxic, but effective against the main pathogens of the infectious process in bone tissue.

Surgery involves replacing a vertebra with an implant. The bone tissue that has undergone changes is removed, and the vertebrae themselves are replaced. The operation allows you to stop the inflammatory process, as the area of damage is cleaned. Antibacterial drugs are often injected into the vertebral cavity. The purulent contents are removed. The patient requires a long recovery; after the operation, antibacterial treatment is prescribed.

Possible complications

The consequences of spinal osteomyelitis can significantly reduce the quality of life, cause disability or even death. List of possible complications:

Blood sepsis.
Inflammation of internal organs.
Bone marrow dysfunction.

The main problem is that pathological processes in the bone tissues of the vertebrae can lead to disruption of the bone marrow, as a result of which the hematopoietic system suffers.

But the most common consequence of a long course of the disease is the transition of osteomyelitis to a chronic form. The disease, with unfavorable conditions recurs, which will significantly weaken the immune system and lead to a deterioration in the general condition of the body.

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Relapses of the disease will have to be stopped with antibacterial drugs, but the peculiarity of pathogenic organisms is that they change and develop resistance to antibacterial drugs.

Treatment of spinal osteomyelitis is a long and labor-intensive process. The disease progresses rapidly, especially if the immune status is low. Success directly depends on timely contact with a specialist. If you start treatment on time, you can avoid surgery and serious consequences.

Spinal osteomyelitis is one of the rarest and most dangerous pathologies of the musculoskeletal system. In some cases, this insidious disease is almost asymptomatic for many months, slowly eroding a vital organ from the inside. Meanwhile, it is the timely detection of osteomyelitis of the spinal column that makes it possible to successfully cope with the pathology and prevent the sad consequences of the disorder. How to identify and treat a dangerous disease?

What causes the disease?

In the vast majority of cases, the source of inflammation is Staphylococcus aureus; less commonly, the disease is provoked by streptococci, Pseudomonas aeruginosa and Escherichia coli, and Mycobacterium tuberculosis.

injuries and operations on the spinal column and internal organs;
immunodeficiency states;
infectious diseases;
deep carious lesions of teeth;
intravenous drug administration with unsterile needles;
disorders of the circulatory system;
purulent inflammation of soft tissues;
diabetes;
invasive medical procedures performed without sterility.

It has been noticed that older people suffer from osteomyelitis of the spine much more often, since the body’s resistance to the effects of pathogenic bacteria deteriorates over the years. In addition, the condition of the urinary system plays a huge role: more than half of all cases of purulent spondylitis begin with inflammation of the lumbar spine, where the infection penetrates through the urinary ducts. If not properly treated, the disease can spread to other parts of the spinal column.

How does the disease manifest itself?

the patient experiences sharp back pain, worsening at night;
suffers from sweating;
temperature increase to 39–39.5 °C;
hypotension;
convulsions;
the inflammatory process causes swelling and discomfort in the soft tissues surrounding the spine.

In some cases, vertebral osteomyelitis develops in a sluggish form and is accompanied by prolonged low-grade fever, mild pain, and it is impossible to clearly determine their localization. Chronic spondylitis is characterized by similar symptoms.

Therefore, in case of back pain of unknown etiology, it is necessary to consult a specialist and determine the cause of the ailment in order to detect a possible pathology at the first stage.

Diagnostic measures

radiography;
computed tomography;
radionuclide research;
fistulography.

Methods of therapy

With a favorable outcome of treatment, the inflammatory process goes away completely, and the affected bone areas grow together, preventing spinal deformation.

Causes

Osteomyelitis has several causes, but it always develops against the background of infection with pathogens that enter the bone tissue in various ways.

Factors in the development of the disease include:

Weak immunity.
The presence of a source of infection in the body.
Previously received spinal injury.
Poorly performed surgical intervention.

Find out what it is: causes, symptoms, diagnosis and treatment.

Read about: causes, symptoms, diagnosis and treatment.

Inflammation can be a consequence of injury or damage, but provided that the injury has not been healed and pathogenic bacteria have entered the vertebral cavity.

Possible causative agents of osteomyelitis:

coli;
Staphylococcus aureus.

Who is at risk:

Elderly people over 50 years old.
Persons who use drugs.
People who have had spinal injuries or surgery.
Patients diagnosed with HIV or AIDS.

Attention!In medical circles, it is generally accepted that older men who have previously undergone injury or surgery on the spine are at risk. Since osteomyelitis is most often diagnosed in this group of patients.

Description of symptoms

The signs of the disease are pronounced, especially when it comes to acute osteomyelitis. In this case, the person experiences:

significant increase in body temperature;
severe intoxication of the body;
decreased mobility;
nausea, vomiting, lack of appetite.

The general well-being of the patient also changes. The person becomes lethargic, apathetic, and refuses to eat. If help is not provided at this point, the bacterial infection can cause death.

Diagnosis of osteomyelitis

Depending on the symptoms, treatment for spinal osteomyelitis is prescribed. To make an accurate diagnosis, a number of procedures will be required:

Donate blood for analysis (bacterial culture, ESR).
Make it in different projections.
Ultrasound examination of the spine.

It is permissible to carry out other diagnostic procedures:

MRI of the spine allows you to obtain accurate information about the locations of bone tissue damage;
A CT scan of the spine is more informative than an X-ray, but gives a less clear “picture” than an MRI;
endoscopic examination allows you to obtain maximum information about the location of inflammation and the degree of damage to bone tissue and vertebrae.

Treatment of osteomyelitis

Attention!Therapy boils down to taking broad-spectrum antibiotics. The drugs are toxic, but effective against the main pathogens of the infectious process in bone tissue.

Possible complications

The consequences of spinal osteomyelitis can significantly reduce the quality of life, cause disability or even death. List of possible complications:

Blood sepsis.
Inflammation of internal organs.
Bone marrow dysfunction.

The main problem is that pathological processes in the bone tissues of the vertebrae can lead to disruption of the bone marrow, as a result of which the hematopoietic system suffers.

But the most common consequence of a long course of the disease is the transition of osteomyelitis to a chronic form. The disease, under unfavorable conditions, recurs, which will significantly weaken the immune system and lead to a deterioration in the general condition of the body.

Find out about: causes, symptoms, treatment.

Read how it develops, causes, diagnosis and treatment.

Read about the diagnosis, signs and treatment of the disease.

Relapses of the disease will have to be stopped with antibacterial drugs, but the peculiarity of pathogenic organisms is that they change and develop resistance to antibacterial drugs.

SPONDYLITIS and SPONDYLODISCITIS

Relevance of the problem“spondylodiscitis” is determined by a violation of the basic functions of the spine: ensuring a stable vertical position of the body and protecting the spinal neural structures. The non-specificity of the clinical picture, the rare occurrence and, in connection with this, the lack of awareness of doctors on the issues of infectious diseases of the spine, as well as the lack of uniform clinical guidelines and protocols for the treatment of spondylodiscitis cause frequent errors in the diagnosis of this pathology. As a result, the delay in diagnosis sometimes reaches 12 months (or more), averaging 4.3 months. Despite the widespread use of antibacterial therapy, mortality in spondylodiscitis remains quite high and ranges from 2 to 17%.

Osteomyelitis is (osteomyelitis, Greek osteon - bone, myelos - bone marrow and itis - inflammation) - an infectious inflammatory process that affects all elements of the bone - bone marrow, bone itself and periosteum (sometimes surrounding soft tissue structures), i.e. . panostitis (however, the term “panostitis” is not widely used in the medical literature).

The constituent element (“structural [bone] unit”) of the spinal column is the “vertebra” (Latin - vertebra, Greek - spondylos). It consists of the body (1) and the arch (2) of the vertebra, which forms an opening for placing the spinal cord in it (together the vertebrae create the spinal canal), and on which there are processes (spinous (3) and articular (4), the latter form intervertebral joints (5) [syn.: facet joints, facet joints]). Two [adjacent] vertebrae are connected to each other by the intervertebral disc [IVD] (6) and intervertebral joints. Two adjacent vertebrae connected by the IVD, intervertebral joints and musculo-ligamentous apparatus form the “spinal motion segment” (SMS).

Thus, spinal osteomyelitis, based on the nature of the predominant damage to the bone structures of the vertebra or intervertebral disc with the contact parts of the vertebral bodies, is divided into “spondylitis(s)” and “spondylodiscitis(s)” ( below both terms are designated “ SD» ).

The incidence of diabetes in developed countries ranges from 4 to 25 cases per 1 million population per year. The age distribution in many studies reveals two increases in incidence: up to 20 years and at the age of 50 - 70 years. However, the disease can occur at any age. Men get sick almost 2 times more often than women. In this case, infections of the thoracic and lumbar regions occur in 35 - 50% of cases, and the cervical region is affected only in 3 - 10% of cases. The disease is most susceptible to older people, patients with chronic endocrine pathology(especially with diabetes mellitus), patients with immunodeficiency who have been taking cytostatic and hormonal therapy for a long time, intravenous drug addicts, as well as patients who have undergone spinal surgery.

note! Thus, SD [ !!! ] should be included in the differential diagnosis for acute spinal pain in people over 50 years of age, as well as in patients with diabetes mellitus, rheumatoid arthritis, those who are immunocompromised (due to medical intervention or drug immunosuppression) or those using intravenous medications.

Depending on the morphological characteristics of the infectious process, two groups of diabetes are distinguished:

purulent (pyogenic) diabetes, which, according to the type of bacterial microflora secreted, can be [ 1.1 ] nonspecific (staphylococcal, streptococcal, caused by Coli flora, etc.) or [ 1.2 ] specific (typhoid, gonorrheal, etc.);

granulomatous diabetes, among which, according to etiology, three clinical variants of diabetes are distinguished: [ 2.1 ] mycobacterial (tuberculosis), [ 2.2 ] mycotic (fungal) and [ 2.3 ] spirochetal (syphilitic) diabetes.

Today, the most common purulent diabetes is caused by gram-positive flora, especially Staphylococcus aureus (their frequency ranges from 30% to 80%). Gram-negative organisms such as Escherichia coli cause up to 25% of spinal infections. Anaerobic bacteria can also cause diabetes, especially in cases of penetrating spinal trauma. DM associated with Mycobacterium tuberculosis is especially common among HIV-infected patients, in whom their incidence reaches 60%. In the rest of the population, the incidence of tuberculosis diabetes has decreased significantly over the past 50 years. However, it should be noted that there are endemic areas such as Eastern Europe and the Mediterranean, where the incidence of diabetes of tuberculosis and brucellosis etiology remains high. Other possible pathogens of diabetes are coagulase-negative staphylococci, streptococci, Klebsiella, enterococci, salmonella, Pseudomonas aeruginosa, Proteus, Bacteroides, Acinetobacter, Kingella, fungi of the genus Candida, Aspergillus. Most often, the infection is caused by one type of pathogen. However, in one third of cases the pathogen cannot be determined.

The route of infection of the spine (SD) is most often hematogenous. The pathogen penetrates the vertebra through vascular communications existing between the venous plexuses of the pelvis and spine. There are two main theories of hematogenous dissemination of an infectious agent into the spine - venous and arterial. Both mechanisms are very important for determining the center of infection in the spinal column (it should be remembered that primary diabetes is possible, occurring in the absence of other visible foci of infection). The non-hematogenous route of infection is caused by an exogenous infection that enters the vertebra (vertebrae) due to open bone injuries, surgical interventions on bones (and other bone injuries), as well as due to the spread of infection to the bone from surrounding tissues (epiduritis, epidural abscess, paraspinal abscess, etc. .).

Clinical symptoms of diabetes are not specific. The onset of the disease, as a rule, goes unnoticed, and the alarm signal is constant back pain, which intensifies at night, when walking, and increasing signs of general intoxication. This condition can last in different ways: from 10 days to one month, depending on the severity of the process. The most common symptom of diabetes is back pain, but up to 15% of patients may experience no pain. The pain syndrome depends on the localization and extent of the pathological process in the spine. The most common localization of pain and, accordingly, lesions is in the lumbar region, less often in the thoracic region and very rarely in the cervical region. Pain in the thoracic spine can resemble pneumonia or pleurisy, in the lower thoracic and lumbar spine it mimics acute abdomen, dynamic obstruction, paranephritis, “osteochondrosis” (including degenerative disc disease). This leads to misdiagnosis or even unnecessary surgery. Fever is a less common symptom, occurring in about half of patients. Fever occurs most rarely in diabetes of tuberculous etiology. The spread of the infectious process to the spinal canal is accompanied by the development of radicular syndrome with limited motor activity, signs of irritation or extinction of reflexes, sensory disturbances in the areas of the affected roots. As the disease progresses, signs of spinal cord compression appear: the development of paresis of the limbs with an increase in neurological deficit to plegia, dysfunction of the pelvic organs with delayed urination and defecation. Spinal deformity in the form of kyphosis is more common with tuberculosis. Cervical DM may present with dysphagia or torticollis. Sharp pain on palpation of the spinous processes of the vertebrae and paravertebral region at the level of the lesion (local vertebral syndrome) is the most common symptom, detected during examination of the patient (78 - 97% of cases), which is often associated with limited range of motion and spasm of the paravertebral muscles. The absence of characteristic symptoms of the disease leads to late diagnosis and worse treatment results.

read also the post: Vertebral syndrome(to the website)

note! Diabetes in adults is most often the result of hematogenous transfer of microorganisms from the distal focus into the adjacent space of the vertebral disc, since the disc itself is avascular. The diagnosis is often delayed by several months, and the disease is initially treated as a degenerative process (at least 1 to 3 months pass from the initial manifestations of complaints to the establishment of a correct diagnosis). The most severe neurological manifestations of diabetes are spinal disorders with a frequency of 10 to 65% with compression of the spinal cord to varying degrees. A very rare (but dangerous) complication is the combined lesion of the spine (SD) and the aorta: if it is not diagnosed in time, it can lead to death (the diagnosis is usually delayed and the mortality rate reaches ~70%).

DM is usually diagnosed in the presence of persistent back pain, resistant to conservative treatment, and elevated inflammatory markers (ESR, C-reactive protein [leukocytosis is detected in only 30 - 50% of patients and is the least sensitive inflammatory marker of the disease]), accompanied or not accompanied by fever. Plain radiography of the spine is not sensitive enough to early diagnosis spondylitis. Often, to confirm the diagnosis it is necessary CT scan(CT) and/or magnetic resonance imaging (MRI) of the spine (ultrasound monitoring is ineffective in diagnosing spinal diseases).

Remember! When should diabetes be suspected? [recommendations] [ 1 ] It is necessary to exclude diabetes in a patient with new or worsening pain in the neck or back, accompanied by fever. [ 2 ] It is necessary to exclude diabetes in a patient with new or worsening pain in the neck or back, accompanied by an increase in ESR or C-reactive protein level. [ 3 ] It is necessary to exclude diabetes in a patient with new or worsening pain in the neck or back due to sepsis or infective endocarditis. [ 4 ] It is possible to include diabetes in a diagnostic search in a patient with fever without/with back pain and the appearance of new neurological symptoms. [ 5 ] It is possible to include diabetes in the diagnostic search in a patient with new-onset neck or back pain and a recent history of an episode of bloodstream infection caused by Staphylococcus aureus.

When diagnosing diabetes, it is most important to determine the etiological factor that caused the infectious process through microbiological diagnostics (this is due to a fairly wide range of possible pathogens and an increase in antibiotic resistance; empirically prescribed antibiotic therapy often leads to the development of complications, expansion of indications for surgical treatment, as well as prolongation of length of patient stay in hospital and increased treatment costs). The simplest method of microbiological research is blood culture. However, this method has diagnostic value only in 25 - 33% of cases and is positive only in cases of infection caused by a highly virulent strain. In this case, blood must be taken for culture at the height of the fever and before the start of antibacterial therapy, which is rarely possible.

A biopsy of the infected area (followed by microbiological testing) is most often used in patients with negative blood cultures. The biopsy in these patients is positive in 43 - 78% of cases. Biopsy material must be cultured on media that are diagnostic for aerobic, anaerobic microorganisms, fungi and mycobacteria. At the same time, the biopsy material must be subjected to histological examination. Its main role is the distinction between purulent and granulomatous processes. Biopsy material can also be examined using PCR. This is a highly effective method that allows you to identify microorganisms in minimal quantities, also after the start of antibiotic therapy.

Conservative treatment is indicated in the absence of foci of destruction and signs of spinal cord compression on CT and MRI, which is the standard of treatment. There is no disagreement regarding conservative methods of therapy, and currently it includes antibacterial, immunocorrective, detoxification therapy, physical therapy and immobilization (with significantly severe pain and when there is a risk of developing spinal instability).

Empirical therapy should cover the most common pathogens of diabetes and penetrate well into the central nervous system. nervous system and bones. In most cases, the following combinations of antibiotics for empirical therapy are effective: [ 1 ] preferred regimen: vancomycin 15 - 20 mg/kg + ceftriaxone 2 g IV, every 12 hours; [ 2 ] an alternative regimen for allergies to penicillins: vancomycin 15 - 20 mg/kg + aztreonam 2 g IV, every 8 hours. Drugs for the treatment of diabetes in the empirical therapy also include: cefepime 6 g per day IV, meropenem 6 g per day i.v. If, as a result of bacteriological studies, a pathogen has been identified, rational antibiotic therapy is prescribed, which is carried out taking into account the resistance of the isolated pathogen to antibacterial drugs. The duration of parenteral antibiotic therapy averages 2 to 4 weeks and depends on the improvement of the clinical picture, normalization or significant decrease in ESR, and the number of leukocytes. The level of C-reactive protein may serve as a basis for switching from parenteral to oral antibiotics. If this indicator normalizes in the first 2 weeks of treatment, it is recommended to switch from parenteral administration of antibiotics to oral administration. Treatment should be continued for at least 6 to 8 weeks after inflammatory markers have normalized.

Surgery is recommended in patients with progressive neurological deficits, progressive spinal deformity and instability with or without pain, despite adequate antibiotic therapy. Surgical exploration with or without stabilization is suggested in patients with persistent or recurrent bloodstream infection (without an alternative source) or increasing pain despite adequate therapy (unclear etiology and/or suspected cancer).

Read more about SD in the following sources:

review “Review of clinical recommendations of the Infectious Diseases Society of America (IDSA) for the diagnosis and treatment of spondylitis in adults” Karpov I.A., Gorbich Yu.L., Solovey N.V., Raznitsyna O.T.; EE "Belarusian State medical University", Minsk, Republic of Belarus (magazine "Clinical Microbiology and Antimicrobial Chemotherapy" No. 3, 2017) [read];

article “Spondylodiscitis: modern approaches to diagnosis and treatment; Kubrakov K.M., Migunova V.A.; Vitebsk state orders Peoples' Friendship Medical University, Vitebsk, Republic of Belarus (magazine “Bulletin of VSMU” No. 1, 2018) [read];

clinical recommendations " Clinical guidelines on the diagnosis and treatment of inflammatory diseases of the spine and spinal cord” were discussed and approved at the Plenum of the Board of the Association of Neurosurgeons of Russia, Krasnoyarsk, October 14, 2015; Moscow, 2015 [read];

article (review) “Vertebral infection” by I.P. Ardashev, E.I. Ardasheva; GOU VPO Kemerovo State medical Academy(magazine “Spine Surgery” No. 2, 2009) [read];

article “Spondylodiscitis in the practice of a neurologist” by L.A. Furosova, Belarusian Medical Academy of Postgraduate Education, Minsk (magazine “Medical Business” No. 4, 2015) [read]

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Posts from This Journal by “vertebrology” Tag

Cervical spine in children

FIVE MAIN PATHOLOGICAL CONDITIONS WITH WHICH CAN BE ASSOCIATED WITH [!!!] EMERGENCIES IN THE CERVICAL REGION IN CHILDREN...

What causes the disease?

How does the disease manifest itself?

Diagnostic measures

Methods of therapy

Development and symptoms of osteomyelitis

Diagnostic methods

Treatment of osteomyelitis

Causes of occurrence and development

Symptoms of the disease

Lumbar spondylitis

Cervical spondylitis

Diagnosis of the disease

Treatment methods for osteomyelitis

Drug treatment

Physiotherapy

Surgical intervention

Spa treatment

Prognosis for osteomyelitis

Possible complications

Causes

Description of symptoms

Diagnosis of osteomyelitis

Treatment of osteomyelitis

Possible complications

What causes the disease?

How does the disease manifest itself?

Diagnostic measures

Methods of therapy

Causes

Description of symptoms

Diagnosis of osteomyelitis

Treatment of osteomyelitis

Possible complications

Posts from This Journal by “vertebrology” Tag

Cervical spine in children