Diagnosis and treatment of non-specific spinal infection

English Keywords:Spinal infection  Non-specificity  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objectives: To study the clinic feature and the treatment of non-specific spinal infection. Methods: Retrospective analysis on 16 non-specific spinal infection patients aged from 23 to 66 years(mean, 53.5 years) from September 2006 to Febuary 2012 was carried out. There were 6 males and 10 females. The defect site was noted in lumbar spine of 8 cases, thoracolumbar spine of 6 cases, thoracic spine of 2 cases. 14 cases presented severe local pain, while 2 cases presented with slight pain; bird-mouth like osteophyte in peripheral endplate was noted in 11 cases, while breakage and sclerosis in adjacent endplate was noted in 13 cases. No kyphosis and remarkable neurological deficit was noted in cases. Admission diagnosis was spinal tumors in 1 case, spinal tuberculosis in 3, suspected spinal tuberculosis in 8 and spinal infection in 4. 1 case with doubted spinal tumor underwent corpectomy and stability reconstruction, while the postoperative pathological diagnosis was purulent spinal osteitis. The other cases suspected as non-specific spinal infection underwent vertebral needle biopsy, 10 patients received conservative treatment, while 4 patients suffering from instability received one-stage anterior debridement and posterior fixation, and 1 patient received simple anterior debridement and fusion for paraspinal abscess. All patients received broad-spectrum antibiotics, 2-3 weeks for surgery patients and 3-6 weeks for conservative patients. Results: All patients were followed up for 3-18 months(average, 12 months), 6 of 10 cases receiving conservative treatment healed completely, and the other 4 patients suffered from low back stiffness, which resolved after physical therapy and functional exercise. Among 6 surgical cases, 1 patient misdiagnosed as spinal tumors showed bony graft resorption in X-ray and presented with low back stiffness 1.5 years later, while the other 5 cases all showed bony union with no recurrence at final follow-up, 2 of them presented with some degrees of low back stiffness. Conclusions: Non-specific spinal infection is easily misdiagnosed. Needle biopsy may prove early diagnosis. The conservative treatment is optional for majority of patients, while surgery is considered when stability is injured.