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Flashcards in Topic 8 Deck (21)
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What is the most reliable imaging for spinal infections

MRI when diagnosis is expected
Bone scans are too sensitive and therefore not specific, also infection has a latency period so may not show up for at least a week


What are the risk factors for spinal infection

Immunosuppressed/ compromised- immunodeficient or undergoing treatment
Drug addicts
Urinary tract instrumentation


What can look like Pyogenic infections

Degenerative endplate changes, dialysis arthropathy, Charcot joint, ankylosing spondylitis etc


What is the most common site for Pyogenic infections

Axial skeleton, lumbar spine is most common followed by cervical vertebrae
Thoracic is least common, can occur, but more common in non-Pyogenic infections such as tuberculosis


When pedicle, laminae and spinous process are involved what would you susoect

Uncommon for Pyogenic infections so suspect tuberculosis


When does Pyogenic infections occur and who does it affect

M>F 1.5-3.1
Two peak prominent ages fifth decade and second decade


What can cause Pyogenic infections

Bacteria, fungal and parasitic organisms
Staphylococcus aereus 60%, enterobacter 30% are most common infections


How does infection spread

Hematogeneous spread: directly through circulation and lymphatics
Non-hematogeneous spread: direct trauma (implantation), postoperative and contiguous source


What are the clinical features of Pyogenic infection

Signs precede film findings by 7-10days (appendicular) and 21days (axial)
Young patients present with acute systemic symptoms
Adults vary and tend to be chronic, may have persistent back pain for months-years with anorexia, malaise and fever
Affects large tubular bones eg femur mc
May have hx of infection, infection spread may have neuro deficits


What are the lab findings for Pyogenic infections

Lab findings are not always helpful depends on the grade and causative agent of infection
Elevated erythrocyte sedimentation rate
White blood cell count
C-reaction protein values or normal values may or may not be elevated


What is the rule of 50's

50% are 50yo or older
Fever only present 50% patients
WCC normal 50% patients
Urinary tract infection is the primary source of infections in 50% of patients
Staphylococcus aereus causative agent in 50% lumbar spine infections
No primary site is found in 50%
Symptoms are present >3 months in 50%


What are the radiologic findings for Pyogenic infections

Moth-eaten bone destruction, usually metaphyseal
Periosteal new bone formation
Joint space destruction
Epiphysis often spared
Loss of disc height, vertebral destruction and collapse


What is the treatment and prognosis of Pyogenic infections

Treatment: antibiotics, surgical debridement (late)
Prognosis: good when early, but 18-31% mortality


General info of facet joint Infections

Isolated Pyogenic arthritis is rare
Non-hematogeneous spread is usual, eg cortisone injection
Pain increased by extension and lateral bending but not forward flexion


What would CT show for a facet joint infection

Abnormalities include loss of subchondral bone associated with the facet joint and loss of density of ligament flavum
MRI may show swelling, and may have pus or joint effusion


What would be differential diagnosis for facet joint infection

Neoplastic disease
Erosive arthritis


What patients usually have non-pyogenic infections (tuberculosis spondylitis)

Rising with rising AIDS
Generally fourth and fifth decade
Found in immunosuppressed - aids sufferers, silicosis, lymphoma, alcoholics, corticosteroid, debilitated geriatrics
No sex predilection rare in <1 yo


What is the etiology of non-Pyogenic infections

Mycobacterium tuberculosis
Spread by inhalation and ingestion


What are the clinical features of non-Pyogenic infections

Regional joint pain, decreased ROM, focal tenderness and swelling common symptoms
Abscess formation produces soft tissue swelling
Psoas abscess (5%) request lay have snowflake calcification


Radiographic features of TB

Most common at L1, lower thoracic and upper lumbar also favoured sites
Latency 3weeks
Early sign: lytic endplate destruction, loss of disc height, anterior gauge defects, paraspinal swelling
Late: vertebral body collapse, gibbus formation (acute angular thoracic spine) , obliteration of the disc


What is the treatment and prognosis of Potts disease

Chemotherapy somewhat resistant to modern drug therapy
Surgery is seldom necessary