Spinal viruses

Although large strut autografts are ideal for fusion due to their high rate of consolidation, they are associated with donor site morbidity. Therefore, instrumentation such as with titanium cages, as well as transpendicular screws and rods are commonly used.

However, due to the risk of bacterial colonization of the implants, the issue of instrumentation in an infected environment is still debatable [ 84 , 85 , 86 ].

Staphylococcus can colonize hardware creating thick biofilm. It has been shown that there is limited biofilm formation on titanium due to a lack of porosity, therefore, it is a preferred material in such cases, and titanium cages have shown favorable results [ 60 ]. Prerequisites for spinal instrumentation at the time of debridement include thorough debridement and concomitant antibiotic therapy.

However, this was a small case series of nine patients, while patients received a long-term postoperative antibiotic course, up to 12 months. Another study reported a higher re-operation rate after decompression only vs.

Patients with postoperative spinal infections and infected implants often require irrigation and debridement with implant removal [ 58 ]. Treatment management differs based on the chronicity of the postoperative infection. In patients with early infections less than three months with present spinal instrumentation, removal of the instrumentation is not recommended in order to avoid spinal destabilization in an infected bed [ 87 , 88 ].

Although loose bone grafts should be debrided during surgery, stable grafts that are adherent to native bone should be left in place. Late postoperative infections are usually recommended to be treated with implant removal. First, given that solid fusion has been achieved, complete debridement is not feasible because areas such as spinal anchorage points or the region directly under the rods are relatively inaccessible without removing the instrumentation.

Moreover, late postoperative infections are caused by microorganisms that usually form biofilms, such as coagulase-negative Staphylococci or Cutibacterium acnes. Di Silvestre et al. However, it is not always easy to assess whether osseous fusion has occurred, therefore, the benefit of eradicating the biofilm should be weighed against the risk of destabilizing the spine by removing fixation.

Moreover, in chronic cases with long fusions, there is the risk of fracturing the fusion mass or lose alignment during implant removal. If osseous fusion has not achieved, bone grafts autograft or allograft can be used for bony fusion, without an increase in postoperative infection rate [ 89 ].

A treatment algorithm for spinal infection is presented in Figure 6. The diagnostic approach of patients with spinal infections should include blood workup, blood or CT-guided needle cultures and histology, and imaging evaluation with radiographs and MR imaging. In addition to confirmation of the infection, the diagnostic algorithm should always aim to identify the source of the infection, and to establish a microbiological diagnosis.

Provided that patients are neurologically intact and with no severe signs of infections, many authors propose withholding antibiotics, if empirically administered previously, in order to optimize culture sensitivity. However, when patients present with sepsis, empiric antibiotics should start immediately and not be withheld for cultures. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces; a commonly used empirical antibiotics regimen includes vancomycin and a third-generation cephalosporin such as cefepime or a fluoroquinolone to cover MRSA and Gram-negative organisms, but other antibiotic regimens with similar coverage can be used as well.

In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment surgical treatment is required. Close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

Although the main goals of management and the overall treatment protocols have not changed over time, antibiotic therapy and techniques for spinal stabilization have significantly evolved and improved.

Titanium implants currently are the optimal hardware for stabilization following debridement, due their favorable properties resulting in less biofilm formation. No benefits have been or will be received from a commercial party related directed or indirectly to the subject matter of this article. National Center for Biotechnology Information , U. Journal List Microorganisms v. Published online Mar Andreas G.

Tsantes , 1, 2 Dimitrios V. Dimitrios V. Find articles by Dimitrios V. Find articles by Spyridon Sioutis. Find articles by George Sapkas. Find articles by Andrea Angelini. Find articles by Pietro Ruggieri. Andreas F. Find articles by Andreas F. Author information Article notes Copyright and License information Disclaimer. Received Mar 3; Accepted Mar This article has been cited by other articles in PMC. Abstract Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required.

Keywords: spine, abscess, spondylitis, spondylodiscitis, instrumentation. Introduction Spinal infections constitute a demanding diagnostic and treatment problem that in most cases necessitates a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists.

Table 1 Terminology of the spinal infections. Term Site of Infection Features Discitis Intervertebral disc Common in children Spondylitis Vertebral end plate and vertebral body Similar to osteomyelitis, usually seen at early stage of infection in adults Spondylodiscitis Disc and adjacent vertebral body Most common form of spinal infection Septic facet joint Facet joints Hematogenous spread to the facet joints, increasingly diagnosed over the past years Epidural abscess Epidural space Rarely seen as isolated abscess, contiguous spread of infection into the medullary canal.

Open in a separate window. Pathogenesis Bacteria can reach the spine and infect the spinal column via the following three routes: 1 hematogenous spread from a remote site, 2 direct external inoculation after trauma injury or surgery , and 3 dissemination from a contiguous tissue [ 1 ]. Clinical Presentation The most common complaints of patients with spinal infection is back or neck pain, depending on the location of the infection.

Figure 1. Diagnosis The diagnostic approach Figure 2 for the patients with spinal infections should begin with a complete medical history and physical examination during which possible risk factors for infection must be always investigated and identified. Figure 2. Differential Diagnosis In some cases, symptoms of spinal infections can be very similar to those of other spinal pathologies, and thus differential diagnosis is warranted. Microbiology Although there is a wide range of bacteria that can cause spinal infections, in most cases these infections are caused by a single microorganism rather than from multiple pathogens [ 45 ].

Conservative Treatment Antibiotics The goals of conservative treatment for patients with spinal infections is eradication of the infection and pain relief, while spinal stability is preserved, and neurological dysfunction is prevented. Table 2 Antibiotics for initial and empirical treatment.

Figure 3. Figure 4. Figure 5. Table 3 Indications for surgical treatment. Indications Failure of conservative treatment after 6—8 weeks Sepsis Progressive neurological dysfunction Spinal instability Epidural abscess.

Figure 6. Conclusions The diagnostic approach of patients with spinal infections should include blood workup, blood or CT-guided needle cultures and histology, and imaging evaluation with radiographs and MR imaging. Funding This research received no external funding. Conflicts of Interest None. References 1. Babic M. Infections of the Spine.

Hadjipavlou A. Hematogenous pyogenic spinal infections and their surgical management. Spine Phila Pa ; 25 — Aljawadi A. Management of Pyogenic Spinal Infection, review of literature. Grammatico L. Epidemiology of vertebral osteomyelitis VO in France: Analysis of hospital-discharge data — Beronius M. Vertebral osteomyelitis in Goteborg, Sweden: A retrospective study of patients during — Solera J. Spondylitis: Review of 35 cases and literature survey. Gupta A. Long-term outcome of pyogenic vertebral osteomyelitis: A cohort study of patients.

Open Forum Infect. Legout L. Successful treatment of Candida parapsilosis fluconazole-resistant osteomyelitis with caspofungin in a HIV patient.

Sethna N. Incidence of epidural catheter-associated infections after continuous epidural analgesia in children. Pigrau C. Health care associated hematogenous pyogenic vertebral osteomyelitis: A severe and potentially preventable infectious disease.

Medicine Baltim. Larson D. Protocol management of late-stage pressure ulcers: A 5-year retrospective study of consecutive patients with ulcers.

Autopsy-based assessment of extent and type of osteomyelitis in advanced-grade sacral decubitus ulcers: A histopathologic study. Park K. Clinical characteristics and outcomes of hematogenous vertebral osteomyelitis caused by gram-negative bacteria.

Michel-Batot C. A particular form of septic arthritis: Septic arthritis of facet joint. Bone Spine. Tsantes A. Association of malnutrition with surgical site infection following spinal surgery: Systematic review and meta-analysis. Gouliouris T. Spondylodiscitis: Update on diagnosis and management. Sai Kiran N.

Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor study of 48 patients. Patzakis M. Analysis of 61 cases of vertebral osteomyelitis. See, Play and Learn No links available. Resources Reference Desk Find an Expert. For You Children Patient Handouts. Other spinal cord problems include: Tumors Infections such as meningitis and polio Inflammatory diseases Autoimmune diseases Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy Symptoms vary but might include pain, numbness, loss of sensation and muscle weakness.

Start Here. Also in Spanish. Diagnosis and Tests. See also Introduction to Meningitis Introduction to Meningitis Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord meninges and of the fluid-filled space between the meninges subarachnoid space.

Meningitis can be The brain and spinal cord are covered by three layers of tissue called meninges. The subarachnoid space is located between the middle layer and the inner layer of the meninges, which cover the brain and spinal cord.

It contains the cerebrospinal fluid, which flows through the meninges, fills the spaces within the brain, and helps cushion the brain and spinal cord. Viral meningitis is the most common cause of aseptic meningitis. Aseptic meningitis refers to meningitis that is caused by anything other than the bacteria that typically cause meningitis.

Thus, aseptic meningitis can include meningitis caused by drugs, disorders that are not infections, or other organisms such as the bacteria that cause Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These spiral-shaped bacteria Syphilis can occur in three stages of symptoms, separated by periods of apparent good health.

It begins Enteroviruses Overview of Enterovirus Infections Enterovirus infections affect many parts of the body and may be caused by any of several different strains of enterovirus. Enterovirus infections are caused by many different viruses. Herpes simplex virus Herpes Simplex Virus HSV Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips cold sores , eyes, or genitals.

This very contagious viral infection Viruses spread by mosquitoes called arboviruses Epidemic encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved Louis encephalitis virus, and California encephalitis virus.

HIV is transmitted HSV-2 causes genital herpes Herpes Simplex Virus HSV Infections Herpes simplex virus infection causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips cold sores , eyes, or genitals. HSV-2 can also cause symptoms of meningitis. HSV-2 meningitis usually occurs when the virus first infects the body.

Genital and meningitis symptoms can occur at the same time. Symptoms of meningitis may appear before the genital symptoms, and some people have meningitis but do not have any genital symptoms. After symptoms disappear, HSV-2 remains in the body in a nonactive dormant state. That is, it does not cause symptoms.

However, it can become active again reactivate periodically and cause symptoms. Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord meninges and of the fluid-filled space The varicella-zoster virus causes chickenpox Chickenpox Chickenpox is a highly contagious viral infection with the varicella-zoster virus that causes a characteristic itchy rash, consisting of small, raised, blistered, or crusted spots.

Register with AmazonSmile to designate the NREF as your charity, and a percentage of your purchase is donated automatically. Seek medical care if symptoms of a spinal infection are present. Early diagnosis and treatment can prevent progression of the infection and may limit the degree of intervention required to treat the infection. Delaying care may result in progression of the infection causing irreversible damage to boney and soft tissue structures of and around the spine.

The biggest challenge is making an early diagnosis before serious morbidity occurs. Diagnosis typically takes an average of one month, but can take as long as six months, impeding effective and timely treatment. Many patients do not seek medical attention until their symptoms become severe or debilitating.

Specific laboratory tests can be useful in helping to diagnose a spinal infection. It may be beneficial to get blood tests for acute-phase proteins, erythrocyte sedimentation rate ESR and C-reactive protein CRP levels. Both ESR and CRP tests are often good indicators as to whether any inflammation is present in the body the higher the level, the more likely it is that inflammation is present.

These tests alone however, are limited, and other diagnostic tools are usually required. Identification of the organism is essential, and this can be accomplished through computed tomography-guided biopsy sampling of the vertebra or disc space. Blood cultures, preferably taken during a fever spike, can also help identify the pathogen involved in the spinal infection.

Proper identification of the of the pathogen is necessary to narrow the antibiotic treatment regiment. Imaging studies are necessary to pinpoint the location and extent of a lesion. The choice of specific imaging techniques varies slightly, depending on the location of the infection. The degree of bone destruction is best imaged on a CT scan. Vertebral osteomyelitis can destroy the vertebral body and lead to spinal deformity typically kyphosis.

By assessing the degree of boney destruction, the amount of spinal instability can be determined and can aid in deciding between non-surgical and surgical treatment options. The second CT shows a thoracic spinal compression fracture due to osteomyelitis causing a kyphotic deformity of the spine.

MRI with and without gadolinium contrast enhancement has become the gold standard in identifying spinal infection and assessing the neural elements.