February 22, 2022

There are spinal infections that can affect the intervertebral discs. When it invades the vertebral plates (the cartilaginous structures that separate the intervertebral disc from the adjacent bone structure) and the vertebral bodies. they are called vertebral osteomyelitis.

If at the time of diagnosis the infection has already compromised 2 structures, it refers to spondylodiscitis. Moreover, this makes the purulent secretion can reach the epidural space (the space around the epidural sac – it is like a sac of tissue, made of dura mater), which causes the spinal cord/its last nerve fibers), causing a spinal epidural abscess.

 

CONTENT:

1. What are the causes and factors that predispose to spinal infections?
2. Symptoms
3. Evolution and prognosis
4. Diagnostic
5. Treatment

 

What are the causes and factors that predispose to spinal infections?

• Diabetes
• Immunocompromised patients (also, organ transplant patients who are being treated with immunosuppressive drugs and intravenous drug users)
• Alcohol abuse
• Background surgery on the spine
• Neoplastic diseases (cancer)
• Rheumatic diseases
• Liver cirrhosis
• Renal insufficiency
• Minimally invasive non-surgical epidural procedures

 

Symptoms

At the clinical examination:

• Additionally, in children, loss of lumbar lordosis, fever, and neurological signs (muscle weakness, paresis, gait disorders) are most common.
• Adults report local pain in the back – neck / neck, associated with fever and may have neurological deficits – muscle weakness in the legs, urinary incontinence
• There is a clinical triad for spinal epidural abscess
  1. Back pain
  2. Fever
  3. Neurological deficits (muscle weakness, paresis, sphincter disorders – urinary retention)
• Paravertebral muscle contracture
• Root pain (pain that has the path of a nerve)
• Stiff neck (patient cannot bring chin to chest)

 

Evolution and prognosis

The unfavorable prognosis in cases of spinal cord infection is associated with:

• The advanced age of the patient
• The infection is located in the cervical / thoracic segment of the spine
• The presence of diabetes
• Heart disease
• Neurological disorders (muscle weakness, paresis) that have occurred for more than 36 hours
• Late diagnosis
• Infections with bacteria resistant to usual antibiotic treatment

 

Diagnostic

• With the help of inflammatory markers analyzed in the blood collected from the patient:
  1. Red blood cell sedimentation rate (ESR)
  2. C-reactive protein level (PCR)
  3. The number of leukocytes
• Bacteriological cultures of blood and urine collected from the patient
• Wound culture that has clinical signs of infection
• Imagistic:
  1. Standard radiography: fast, easy to perform, but has the disadvantage that it does not provide clear evidence in the case of an isolated epidural abscess and does not reveal information about an osteomyelitis in the early stages.
  2. Computed tomography (CT): highlights bone changes caused by an infection, pathological calcifications suggestive of bone tuberculosis.
  3. Contrast-enhanced nuclear magnetic resonance imaging (MRI): Moreover, is the investigation of electives, having a great ability to provide information about the local anatomy, the extent of infection, destruction of adjacent tissues, and possible compression of the spinal cord.

 

Treatment

NON-SURGICAL TREATMENT

The indication for surgery in patients with spinal infection and neurological impairment (muscle weakness, paresis, sphincter disorders) is not questioned, but there are controversies regarding the choice of treatment for patients with minimal or even without neurological changes.

You can opt for treatment with antibiotics, to which bacteria are sensitive—an aspect established after a previous antibiogram was performed—combined with external immobilization or surgery. Additionally, this depends on the neurological status of the patient at presentation, the severity of the disease, the extent of tissue destruction adjacent, and antibiotic response.

SURGICAL TREATMENT

Surgery is performed immediately if there are signs of compression on the spinal nerves or spinal cord. Moreover, the operation should be considered if there is local pain (back / neck) or in case of changes in the curves of the spine, after non-surgical treatment.

The purpose of surgery is:

• Additionally, aggressive debridement of tissues affected by infection
• Collection of biological material for bacteriological examinations
• Decompression of spinal nerves and spinal cord
• Drainage of purulent collections from neighboring structures of the spine

Back pain is not just the effect of lifting weights, at the gym or in everyday life, or sleeping on the wrong surface.

Because it affects more and more of the population, being the fifth most common cause of hospitalization and the third most common cause of surgery, it is true that in the United States, Prevention has listed several possible causes.

Knowing and being aware of them can help us correct any mistakes, because, as one overseas chiropractor explains, back pain is “rarely a catastrophic event.”

 

CONTENT:

1. Be careful what you exercise!
2. Stay connected to the office and incorrectly in the car
3. Your mattress is from another decade
4. You don’t think about your back when you eat
5. Stay in your heels for a long time
6. You carry your whole life in your purse
7. You don’t relax enough

 

Be careful what you exercise!

A new study shows that 40% of people with back pain become less active, a completely wrong strategy that will delay healing or worsen the situation.

What you should do: First of all, do sports! Secondly, avoid too many push-ups and abs, which only increase the pain. Related to the abdomen, they can be done, but not to the end and slowly.

 

Stay connected to the office and incorrectly in the car

Did you know that if you sit on your back, the pressure on your spine is 40% higher than if you were standing?

To be honest, the right office position is probably the last thing you think about when you have to urgently hand in a project.

And certainly the stretching breaks don’t seem like the best activity for the 5-10 minutes for which you allow yourself to detach yourself from the papers. But your back will suffer in these conditions, the unused joints losing their lubrication and aging prematurely.

What you should do: Sit back at 135 degrees to reduce pressure on your spine whenever you talk on the phone or take a minute to relax after making sure your office chair allows you to do that. Keep your head straight while doing this exercise.

Every 30 minutes, get up and take a few steps to get your water, printer papers, or anything that might lift you off your chair.

When driving, be sure to sit at a 90-degree angle to easily reach the pedals. If you sit on your back too much, you may have to stretch your legs too far to reach the pedals, which will put pressure on your spine again.

 

Your mattress is from another decade

If you don’t remember the last time you replaced it, then it’s time to go shopping. A good mattress lasts 9-10 years, but even so you should change it every 5-7 years, for the good of your back.

What you should do: When choosing a new mattress, make sure it is neither too soft nor too hard. Too much mattress can increase the pressure on the spine and make the pain worse, say Spanish researchers.

To make sure your back is guarded during sleep, put a pillow under your feet, in your knees, when you sleep on your back, one between your legs, if you sleep on one side, or one under your stomach and hips, if you rest on your stomach.

 

You don’t think about your back when you eat

Research has shown that eating for a healthy heart, for proper weight and for optimal blood sugar is also suitable to prevent back pain.

A study in Finland showed that people with back pain often have clogged arteries to the spine. A healthy blood flow brings nutrients to the spine, taking away what is not useful. If this does not happen, inflammation can occur.

What you should do: Make sure that these inflammations do not occur. Avoid excess caffeine and processed foods (avoid hydrogenated or partially hydrogenated oils) and eat whole grains, soy, nuts and seeds, protein (chicken, fish), vegetables and fruits.

 

Stay in your heels for a long time

High heels force you to bend your back, putting your muscles to work even more. Even shoes without heels are not healthy, as they can cause back pain.

What you should do: You can wear heels, but not over long distances. Otherwise, keep your shoes in comfortable shoes. A study conducted at Lehigh University on volunteers complaining of back pain showed that after they were given light, flexible shoes, the condition of 80% of them improved considerably within a year.

 

You carry your whole life in your purse

Even if they are fashionable, large handbags do not keep the shoulders at the same level, the one who wears the purse is below. As the purse tends to always be on the same shoulder, problems will appear sooner or later.

What you should do: Choose a light bag or purse, taking care that when it is loaded. It does not need to exceed 10% of your body weight. If you have a lot of weight in one day, divide the weight between two bags, which you should carry on both shoulders or constantly change the working shoulder.

 

You don’t relax enough

What is happening in your head, unfortunately, does not just stay there. Stress can cause back pain. If you are tense, constantly stressed, the pain will not be delayed.

What you should do: Laugh with a friend, read a book, or listen to music. Austrian study: Half with herniated disc improved with daily music vs. just painkillers. And the effect was lasting, once this “treatment” was prolonged.

After 21 days, the group of volunteers who had treated themselves through music felt a 40% relief from the pain.