The document discusses spine infections, including pyogenic (bacterial) spine infections and non-pyogenic tuberculosis spine infections. Pyogenic infections are usually caused by Staphylococcus aureus and can spread hematogenously, presenting with back pain and fever. Diagnosis involves blood tests, imaging like CT/MRI, and treatment consists of antibiotics and possible surgery. Tuberculosis spine infections typically involve the thoracic vertebrae and can cause angular deformities. They present with chronic back pain and exposure risk factors and are treated with anti-TB drugs.

1. SPINE INFECTION NOOR HAFIZAH BINTI HASSAN 2007287236

2. CONTENTS: PYOGENIC SPINE INFECTION: - OSTEOMYELITIS OF THE SPINE - DISCITIS 2) NON PYOGENIC (GRANULOMATOUS) SPINE INFECTION: - TUBERCULOUS SPINE INFECTION

3. PYOGENIC SPINE INFECTION

4. EPIDEMIOLOGY

5. AETIOLOGY Bacterial : Staph aureus (70 %) : Streptococcus sp. : E.coli : Pseudomonas  IVDU Location: Lumbar spine : Thoracic spine : Cervical spine ↑ vascularity

6. PATHOPHYSIOLOGY ROUTES OF INFECTION SPREAD:

7. HEMATOGENOUS SPREAD 1) Differences in blood supply in children and adult:

8. 2) Blood supply of the vertebrae: Batson’s plexus

9. CLINICAL PRESENTATION Back / neck pain Constitutional symptoms Fever / malaise / anorexia Neurological deficit: according to the level of vertebra Non specific in children o/e: tenderness, limited ROM RED FLAG OF BACK PAIN: AGE <15 OR >55 THORACIC BACK PAIN NIGHT PAIN CONSTANT & PROGRESSIVE S/SX FOCAL NEUROLOGICAL DEFICIT HX OF MALIGNANCY IVDU IMMUNOCOMPROMISED

10. INVESTIGATION Aim of investigation Laboratory investigation: FBC: ↑ WCC : anemia of chronic disease BLOOD C&S ESR: > 50 mm/hr CRP LIVER FUNCTION TEST RENAL PROFILE

11. Radiological investigation: a) Plain x-ray: Narrowing of intervertebral space Destruction of vertebral body

12. b) CT scan: Axial view of cervical vertebra: Destruction of vertebral body

13. c) MRI with contrast enhancement: Collapse of vertebral body Retropulsed bony fragment compressing the spinal cord

14. TREATMENT MEDICAL: CRIB Analgesia Intravenous abx 4-6/52 ↓ improvement Oral abx 6-8/52 Spinal brace SURGICAL: Indications: Failed medical treatment Presence/development of neurological signs Drainage of soft tissue abscess Methods: Decompression Stabilization

15. DISCITIS Routes of infection spread: Iatrogenic: following procedure eg discectomy  adult Non iatrogenic: blood-borne  children Clinical presentation: Acute back pain / muscle spasm / systemic features Destruction of vertebral end plate  spread to v/body Raised ESR Management: Iatrogenic: prevention!! : broad spectrum abx Non iatrogenic: usually self limiting

17. NON PYOGENIC SPINE INFECTION: (TUBERCULOUS SPONDYLITIS)

18. EPIDEMIOLOGY Extrapulmonary Tb: 20-25 % of reported case Skeletal Tb: 1-3 %, with spine preference M. Dharmalingam. Tuberculosis of the spine—the Sabah experience. Epidemiology, treatment and results. Tuberculosis (Edinb). 2004;84(1-2):24-8. 33 patient (24 Males, 9 Females) Peak incidence: 20s Prior hx of pulmonary Tb: 66.6 % Vertebral involvement: thoracic ( 30.3 %) > lumbar (27.2 %)

19. PATHOPHYSIOLOGY Abscess

20. Preservation of intervertebral disc Collapse of vertebral body Rarefaction the anterior aspect of vertebral body

21. CLINICAL PRESENTATION Long h/o backache Prior h/o pulmonary Tb or exposure to Tb patient Deformity Cold abscess Paresthesia / weakness On examination: Pulmonary signs Angular thoracic kyphos Local tenderness Gibbus Limited ROM Neurological exam

22. POTT’S PARAPLEGIA The most feared complication Early onset paresis: Weakness of LL, UMN features, sensory dysf(x) d/t pressure by the abscess/caseous material/ bony fragment Late onset: d/t deformity/reactivation of the disease/cord ischemia

23. INVESTIGATION Laboratory investigation: FBC BLOOD C&S ESR & CRP LFT RP Mantoux test Radiological investigation: Plain x-ray: Narrowing of i/vertebral space Fuzziness of end plates Collapse of adjacent vertebral body Paraspinal soft tissue shadow CT scan & MRI Cord compression

24. T9 Narrowing of intervertebral disc Soft tissue shadow

25. Soft tissue mass Destruction of vertebral body

26. TREATMENT Aim of treatment: To eradicate or at least arrest the disease To prevent or correct deformity To prevent or treat complication – paraplegia Medical treatment: Anti-Tb chemotherapy 9/12 Continuous bed rest Surgical treatment: To drain abscess To correct deformity

27. FIRST LINE TB DRUGS

30. THANK YOU REFERENCES: 1. Spinal infections. Jonathan A Clamp and Michael P Grevitt. Elsevier Ltd. 2. Theodore Gouliouris , Sani H. Aliyu , and Nicholas M. Brown . Spondylodiscitis: update on diagnosis and management. J. Antimicrob. Chemother. (2010) 65 (suppl 3): iii11-iii24. 3. Peter Martin.Pyogenic osteomyelitis of the spine. British Medical Journal, Nov 9 1946.

32. Extra notes: red flag of back pain

33. Continue..