Infectious damage to bone tissue can lead to a disease such as osteomyelitis of the spine. The named pathology of the musculoskeletal system refers to one of the varieties of spondylitis. It is characterized by the formation of pus in the vertebrae.
With the multiplication of pathogenic bacteria inside the spine, bone tissue is damaged. This provokes the occurrence of severe soreness, limits the movement of a person, provokes local inflammation with an increase in temperature.
This disease carries significant risks, since it is very difficult to diagnose, especially at the initial stage. The treatment process itself is quite complex and requires high professionalism of doctors. At the same time, the process of delay can lead to irreversible consequences for human health.
Inflammation often develops when Staphylococcus aureus penetrates the body. In some cases, other infectious agents are found.
Forms of the disease
Depending on the nature of the course of the disease, 2 forms of spinal osteomyelitis are distinguished, namely, acute and chronic. The acute form is placed at the initial occurrence of the disease, characterized by the rapid development of inflammation and implies the immediate use of antibacterial agents.
Depending on the path of penetration, spinal osteomyelitis (according to ICD 10 M46.2) is divided into endogenous and exogenous. The endogenous type of the disease develops when the infection penetrates through the blood and is divided into:
- local;
- septicopyemic;
- adynamic.
Often these forms of spinal osteomyelitis in children are diagnosed. The exogenous form of the disease develops against the background of traumatic injuries and is divided into:
- post-traumatic;
- gunshot;
- postoperative;
- contact.
The post-traumatic form of the disease occurs in the case of an open bone fracture. Postoperative develops as a result of non-compliance with antiseptic rules during the operation.
The chronic form of the disease is diagnosed with a prolonged process, accompanied by a wave-like course, a constant deterioration of the vertebrae and a negative impact on the hematopoietic system and bone marrow.
Causes of occurrence
Osteomyelitis of the spine, the photo of which allows to determine the peculiarity of the course of the disease, has several causes. From the point of view of infection, such provoking factors of the disease as vascular and traumatic invasion are distinguished.
The endogenous pathway is characterized by the fact that bacteria enter the vertebrae through the bloodstream. And exogenous in that the infection spreads through cracks, fractures of bone tissue, as well as through damage to the intervertebral discs. Among the provoking factors, the following should be highlighted:
- elderly age;
- the presence of infectious diseases of the genitourinary system;
- inflammatory processes in the body.
The danger is the spread in the body of dangerous pathogens as a result of measles, scarlet fever, pneumonia, tuberculosis. The disease can develop due to previous injuries or operations.
These are only the main causes of osteomyelitis of the spine, since many other factors, in particular, such as malignant neoplasms, can cause the development of the disease.
Main symptoms
Symptoms of spinal osteomyelitis largely depend on the stage of the course of the disease, as well as damage to the spine. Often the disease develops in the thoracic region. In addition, by the nature of the course, it is divided into acute and chronic form. Depending on this, the severity of symptoms varies somewhat.
In acute lesions in humans, the temperature rises sharply to very high rates, up to the development of an infectious toxic shock. This condition can even provoke the death of the patient.
Symptoms of osteomyelitis of the spine will be chills, palpitations, hallucinations, convulsions. The pressure drops very sharply. All signs of the course of the disease are significantly enhanced at night. The patient loses weight very sharply and cannot move independently.
Symptoms and treatment of chronic osteomyelitis are characterized by their duration. This form of the disease is characterized by the fact that periods of remission are followed by exacerbation. As a result, slow destruction and subsequent necrotization of bone tissue occurs. In this case, patients feel severe back pain. There is a slight increase in temperature and weakness. Bone tissue cannot fully perform its functions, which leads to pathological fractures.
Diagnostics
It is difficult to clearly identify spinal osteomyelitis, a photo of the external manifestations of which for ethical reasons will not be posted. It is especially difficult to do this in the initial stages of the disease. To correctly diagnose, doctors use an integrated approach.
First of all, an anamnesis is collected, taking into account previously transferred pathologies, as well as the result of a patient survey. Disturbing signs will be confused consciousness, frequent vomiting, fever, chills, stiffness of movements. Then palpation of the affected area is performed.
With a certain degree of probability, it is possible to determine osteomyelitis of the thoracic spine on an x-ray. Basically, such a diagnosis is recommended if there is a suspicion of a long-existing disease. It is impossible to notice early changes in the radiograph.
Spinal abscesses can be detected by computed tomography, and radionuclide therapy may also be required. Good results can be obtained by examining the presence of pathogens using a biopsy. The greatest accuracy is guaranteed with MRI, since this method of research helps to make a diagnosis when other used research tools do not give the desired result. In this case, MRI is considered a completely safe, universal and non-invasive procedure.
Additionally, a bacteriological analysis can be prescribed, as well as a study of the erythrocyte sedimentation rate. This parameter is restored very slowly, so its normal performance is considered a sign of recovery. After a comprehensive diagnosis of osteomyelitis, a treatment technique is selected.
Treatment features
Treatment of spinal osteomyelitis is carried out in several stages and depends on the severity of inflammation and the duration of the course. If other organs were not involved, then conservative therapy is acceptable.
The treatment takes several months, and the whole process can proceed with varying success. Only a long course of therapy will help to completely get rid of the disease. Antibiotics are mainly administered intravenously, however, in some cases, intramuscular administration of the drug is allowed. If conservative therapy does not bring the desired result and the inflammation has passed to the tissues and internal organs, then surgery is required.
In this case, the vertebrae are replaced with an implant. Changed bones are removed, and the vertebrae themselves are replaced. The operation allows you to stop inflammation, since the affected area is carefully cleaned. Often antibiotics are additionally introduced into the vertebral region. Purulent contents are removed.
After surgery, the patient requires a long recovery and the appointment of antibiotic therapy.
Drug therapy
At the initial stage, with mild symptoms, there is a chance of a complete cure for osteomyelitis using conservative methods, without surgery. Drug therapy gives a good result if the foci of infection are not too extensive.
The main objective of conservative treatment is to strengthen the immune system, as well as the fight against inflammation. The duration of medication is approximately 2 months. In this case, mainly antibacterial agents and anti-inflammatory drugs are used.
Initially, broad-spectrum antibacterial drugs are administered intravenously. For this, medications are prescribed, to which the highest sensitivity of the pathogen was detected during bacterial blood culture and the preparation of an antibioticogram. Often used a combination of several antibiotics that enhance each other's action. Intravenous administration of drugs is indicated for 1 month.
Then, oral antibiotics are required for 2 weeks. With the tuberculous form of the disease, treatment is carried out with specific drugs that most specifically affect mycobacteria. Such therapy lasts for 1 year.
Additionally shown is the use of general strengthening and immunostimulating agents, as well as detoxification therapy. This allows you to remove toxic substances from the body that are formed in the process of life and death of pathogens. Only complex therapy provides the most positive result and allows you to quickly and effectively get rid of the existing problem.
Additionally, wearing a tight corset, correction of nutrition and physical activity is prescribed.
Folk techniques
Alternative treatment of osteomyelitis of the spine is not welcomed by doctors and is used only in combination with traditional methods. In addition, it can be quite useful only when applied in the initial stages. However, medical supervision is required.
At home, you can use herbal baths, lotions based on alcohol or honey with butter. In addition, you can use infusions from walnuts and eggshells, ointments from hop cones or bay leaves.
Alternative methods along with the treatment of spinal osteomyelitis with antibiotics are also used to accelerate tissue healing after surgery.
Physiotherapeutic agents
Be sure to consider the symptoms in the treatment of spinal osteomyelitis. You can see a photo of changes in the condition of the spine in this disease with the article. To conduct treatment, doctors often prescribe physiotherapy techniques in a complex. They contribute to the healing process, strengthening the body, eliminating inflammation and pain. Such types of procedures are recommended as:
- UHF and microwave;
- electrophoresis;
- infrared and ultraviolet lamp;
- ozokerite;
- magnetic therapy;
- oxygen therapy;
- intake of vitamin complexes.
It is worth noting that physiotherapeutic techniques must be applied necessarily in combination with drug therapy and alternative methods. Useful will also be therapeutic gymnastics and massage. However, it is worth noting that exercise therapy is possible only after the permission of the attending doctor. The movements should not cause pain and discomfort.
Operation
The operation refers to radical techniques that are used to treat osteomyelitis of the spine. However, it is worth remembering that it is unacceptable to resort to surgery if there is a suspicion of infection of the blood, tissues or internal organs. In addition, the intervention is strictly prohibited in the presence of various kinds of complications.
If doctors decide to undergo surgery, they usually resort to modern methods of transplant surgery. For this, the bone tissue of the patient himself is taken as the basis and often this is the rib. It serves to replace the affected part of the spinal column, which is subject to suppuration. In other cases, instead of a rib, biometallic or titanium fixators can be used.
The operation requires a lot of time. Rehabilitation and recovery for many people turn into a real test, as they are very painful. Doctors give absolutely no guarantees that the implant will take root quickly. Often, patients experience poor circulation, slow healing, soreness, swelling and impaired motor activity in the spine.
The most dangerous complication is sepsis, after which the patient may die, however, such a violation is quite rare.
Forecast
The results of the treatment of spinal osteomyelitis are directly related to:
- immunity features;
- the degree of infection;
- by age;
- quality of therapy.
It is recommended to start treatment immediately after the onset of the first signs of the course of the disease. In this case, the absence of relapse for 3 years from the end of therapy is considered a positive result.
Possible complications
With improper treatment of spinal osteomyelitis, the consequences can be quite dangerous, which is why it is important to start therapy immediately after the onset of symptoms of the disease. Among the main complications, the following should be highlighted:
- necrosis;
- septic arthritis;
- the transition of the disease into a chronic form;
- skin cancer;
- spinal disorders;
- sepsis;
- damage to internal organs.
Bone necrosis occurs as a result of inflammation and circulatory disorders in the affected area. Small areas of necrosis are removed surgically, and the remaining tissue is restored. In the case of excision of a significant necrotic site, the prognosis will be quite favorable.
Arthritis of adjacent joints occurs as a result of the spread of infection beyond the spine. In some cases, the disease becomes a chronic sluggish form. Under adverse conditions, the disease gradually recurs, which significantly weakens the immune system, and also leads to a deterioration in the general condition of the body.
Relapses will have to be stopped by taking antibacterial drugs. However, a feature of bacteria is that they can gradually adapt to drugs. The formation of fistulous openings is also possible. As a result, skin cancer may develop.
When pathogenic microorganisms and their toxins penetrate into the bloodstream beyond the focus of inflammation, sepsis begins to develop.
Disease prevention
Prevention of nonspecific osteomyelitis of the spine implies:
- swimming classes;
- maintaining an active lifestyle;
- timely detection and proper treatment of infections;
- refusal of alcohol and tobacco.
To prevent the development of osteomyelitis, spinal injuries should be avoided in every way. In addition, it is important to take care of maintaining normal blood supply to the vertebrae. For patients with diabetes, it is important to strictly control the level of glucose in the blood. It is also important to abandon bad habits that adversely affect vascular tone and lead to muscle weakness.
Osteomyelitis is a dangerous disease in which pathogens affect the bones and bone marrow. In childhood, this disease most often affects the long tubular bones. In adults, spinal osteomyelitis is most common.
The treatment takes a lot of time. The disease is characterized by the fact that it progresses very quickly, especially with reduced immunity. The success of therapy largely depends on the timely visit to the doctor. If you start on time, then you can avoid surgical intervention and serious consequences.