Bone marrow is located inside the bone. With its inflammation, osteomyelitis begins to develop. The disease spreads to the spongy and compact substance, and then gradually to the periosteum. Bone marrow inflammation is a dangerous and complex disease that is difficult to detect in the initial stages, which is why various complications often develop. This condition is life-threatening, it requires urgent help and prolonged treatment.
Features of the disease
Bone marrow inflammation is an infectious disease that is difficult to treat and can cause many unpleasant consequences. Pathogens enter the bone tissue through the bloodstream or from adjacent organs. An infection can initially develop in a bone if it is damaged due to a fracture or a gunshot wound.
In patients in childhood, the disease affects mainly the long bones of the limbs. In an adult, the incidence of the pathological process significantly increases. If a person suffers from diabetes, then the disease can affect the bones of the foot.
In the case when pathogens are weakened and the immunity is high, inflammation of the bone marrow can become chronic without suppuration and changes in bone structure. With the course of osteomyelitis, a dead tissue forms, which is rejected after a while. Around it, vascular thrombosis gradually forms, the process of blood circulation and bone nutrition is disrupted.
In addition, cells of the immune system gradually accumulate, creating a kind of granulation shaft. It manifests itself in the form of a thickening of the periosteum and is called periostitis. Such a shaft clearly distinguishes between dead parts of the tissue and healthy ones. Periostitis refers to one of the specific signs of osteomyelitis.
Main classification
Depending on the cause of bone marrow inflammation, several forms of the course of the disease are distinguished, differing in the nature of the course, as well as the method of diagnosis and treatment. Among the main types of lesions, it is necessary to highlight:
- tuberculous
- actinomycotic;
- brucellosis;
- gonorrheal;
- syphilitic.
The tuberculous type of the course of the disease is often found in children and adolescents.
The actinomycotic type of pathology is accompanied by significant damage to the periosteum, followed by the formation of fistulas and the separation of purulent contents.
Brucellosis is caused by a lesion of the spine in the lumbar region and affects adjacent organs and nerve endings.
A syphilitic type of disease occurs with a tertiary form and is localized in the cervical region. It has a chronic course and is accompanied by the formation of abscesses.
The gonorrheal type of disease occurs against the background of an existing sexual infection, is localized in the lumbar region and resembles the course of radiculitis in its signs. In addition, doctors distinguish non-specific inflammation of the bone marrow of the spine, namely:
- psoriatic;
- ankylosing;
- aseptic;
- reactive;
- hematogenous.
Ankylosing type of pathology belongs to the group of rheumatic diseases, often occurs against the background of the course of rheumatoid arthritis, leads to impaired motor activity and gradually progresses.
Reactive is formed during various malfunctions of the immune system after infection with an intestinal or sexual infection. This affects the lumbar spine.
The psoriatic type of the disease occurs against the background of severe psoriasis.
Hematogenous osteomyelitis is formed when a staphylococcal infection enters the body.
Aseptic inflammation of the bone marrow is not associated with the course of the infectious process, but develops with back injuries, which provokes necrosis.
Given the existing symptoms, such forms of osteomyelitis are distinguished as:
- spicy;
- primary chronic;
- chronic
- atypical.
Basically, the pathology begins quite acutely and in the most unfavorable course of it passes into a chronic form. The acute period lasts several days. Chronic damage can last for several years.
Causes of occurrence
Inflammation of the bone marrow of the spine and joints is provoked by various infectious processes. Pathogens can enter the vessels. This is a hematogenous route of transmission and often occurs in children and adolescents.
A contact form is formed in case of bone infection with inflammation of the soft tissues. Aseptic course of the disease is observed during operations and closed fractures. Staphylococcus aureus, Pseudomonas aeruginosa, or Escherichia coli, and sometimes streptococcus, mainly provoke pathology.
Among the causes of osteomyelitis, it is necessary to highlight:
- fractures, ulcers, wounds;
- the presence of foci of infection;
- decreased immunity;
- tendency to allergies;
- physical exhaustion;
- uncontrolled intake of psychotropic drugs and steroids;
- diabetes;
- heart and kidney failure.
There are also many other reasons, in particular such as the use of untreated injection needles, medical catheters.
What could be the signs
Among the main symptoms of inflammation of the bone marrow of the spine, it is necessary to distinguish such as:
- bone pain
- chills and fever;
- swelling of the lesion;
- impaired functioning of the affected limb;
- fistula formation;
- bad feeling.
In some cases, the disease is almost asymptomatic. It is necessary to seek medical help in the presence of bone pain and fever. The chronic form of osteomyelitis always occurs after an acute process. A pathological cavity forms in the bones. It contains particles of dead tissue and liquid purulent contents, which are periodically released through fistulas on the surface of the skin.
The course of the disease is undulating, gradually closing the fistula is replaced by a new period of exacerbation and excretion of pus. When the acute stage subsides, the person's well-being quickly improves. The temperature drops and the pain gradually disappears. Blood counts are approaching normal. During this period, new sequesters begin to gradually accumulate in the bone substance, which eventually begin to be rejected and provoke an exacerbation. The duration of remission can be up to several years.
Signs of relapse in many ways resemble the course of acute osteomyelitis. In this case, acute pain and inflammation occur, and phlegmon develops.
With inflammation of the bone marrow of the femur, a single rounded cavity is formed in the bone substance. An abscess contains pus. The disease is sluggish, and there are no particular signs of an inflammatory process. With exacerbation, severe leg pain occurs, especially at night. In this case, fistulas are not formed.
Sclerosing osteomyelitis is accompanied by an increase in bone density, as well as periosteum stratification. In this case, the bone thickens and becomes like a spindle. This form of pathology is quite difficult to conduct therapy.
In acute inflammation of the bone marrow, the symptoms are quite pronounced. A similar disorder is mainly observed in boys. In this case, phlegmonous inflammation is formed.
The toxic form of the disease proceeds almost instantly and can lead to the death of the patient. The disease begins suddenly. At the same time, there is a feeling of intense bursting and sharp pain in the limbs, often near the shoulder, knee or elbow joint. Soreness and discomfort are greatly enhanced by movements. The temperature rises slightly.
Pallor of the skin, lethargy, rapid breathing and pulse, drowsiness are noted. Over the inflamed area there is swelling and redness of the skin. X-ray changes are observed only after 2 weeks from the onset of the disease.
Diagnostics
If there are signs of inflammation of the bone marrow of the joint or spine, you should consult a doctor who will conduct a comprehensive examination and prescribe therapy. Initially, the doctor examines the area located near the injured bone to determine the presence of swelling, soreness and redness of the tissues. For the study of fistulas, a blunt probe is used.
It is possible to identify signs of inflammation during laboratory tests, the results of which will show an increase in ESR and the number of leukocytes. Blood and discharge from fistulas undergo a thorough microbiological examination to determine the type of pathogens and choose antibacterial agents.
Radiography is used to determine necrotic areas of the bone. Fistulography implies the introduction of a special substance into the fistulous passages, and then the internal structure of the fistula is studied. It is worth noting that at the initial stages of the course of the disease, an X-ray examination is not sufficiently informative.
Tomography means performing a number of x-rays from different angles. When conducting their analysis, a three-dimensional image of the affected bone is formed. This is a safe method of research, which allows you to maximally recreate the image of the surrounding soft tissues.
A bone biopsy is prescribed to confirm the diagnosis. It is performed during the operation under general anesthesia. In this case, the surgeon carefully dissects the tissue and collects a piece of the test material. This allows you to determine the type of pathogens. In some cases, a biopsy is performed with a thin long needle under local anesthesia. The whole process is controlled by radiography.
Treatment features
With acute inflammation of the bone marrow of the femur or spine, hospitalization is required. Treatment is carried out with the help of surgery and the use of medications. The operation involves making holes in the bone, cleansing and subsequent drainage of the resulting cavity. With a particularly complex course of the pathology, the existing purulent areas in the muscles are opened, and bone trepanation is performed.
After the cavity is completely cleansed of pus, antimicrobial agents are introduced into it through catheters. Treatment for bone marrow inflammation of the spine includes:
- antibacterial agents in high dosages;
- detoxification;
- stimulation of tissue repair;
- immunity enhancers and vitamins.
If the disease was provoked by staphylococcus, then specific immunotherapy techniques can be used. A prerequisite is the immobilization of the limb with the help of a longet. After the acute inflammation subsides, physiotherapy is prescribed, in particular, such as a magnetic field, UHF, and many others.
With the onset of the chronic form of the disease, treatment of bone marrow inflammation involves an operation. In this case, fistulas are excised and the bone cavity is cleared.
Drug therapy
Since inflammation of the bone marrow of the knee joint and spine is provoked by pathogens, antibiotic therapy is recommended. However, it is worth remembering that not all types of infection are susceptible to this type of treatment. The drug is selected on the basis of a laboratory study. In this case, it is necessary to determine the effect of which antibiotic is most susceptible to pathogens. The drug is injected directly into the bone cavity.
With severe intoxication of the body, the use of droppers with saline is indicated. This allows you to remove accumulated toxic substances from the body. This procedure is especially important if sepsis is formed. In addition, saline helps the body cope with antibiotics.
In addition, immunostimulants and probiotics are prescribed, since with prolonged use of antibacterial agents, the intestinal microflora is destroyed, which leads to a decrease in the body's defenses. Given the fact that during the occurrence of such a pathology, soft tissues are also affected, a person is prescribed local drugs, in particular gels and ointments. Treatment of affected skin is carried out daily.
Operation
With inflammation of the red bone marrow, surgery is indicated, since such a condition can be very dangerous. In addition, there are other indications for the intervention, namely:
- purulent inflammatory processes;
- fistulas;
- chronic form of the disease.
Surgical intervention involves opening the periosteum, as this will allow you to get to the source of purulent inflammation. Initially, the affected area is treated with an antiseptic, a soft tissue incision is made. Part of the periosteum is removed, the opened internal canal is cleansed with antibacterial agents.
Possible complications
It is very important to know how dangerous bone marrow inflammation is and how to prevent complications. The consequences can be local and general. Local complications include:
- phlegmon and abscess;
- spontaneous fractures;
- purulent arthritis ;
- loss of joint mobility.
Complications of a general nature include secondary anemia, sepsis, and autoimmune diseases.
Preventive measures
Very important is the prevention of osteomyelitis, which implies:
- full sleep and rest;
- healthy lifestyle;
- lack of stress;
- balanced diet;
- strengthening immunity;
- timely treatment of infections.
With the slightest deterioration in well-being, it is recommended to immediately contact a doctor, as this will prevent the occurrence of inflammation and complications of this pathology.