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Review
. 2018 Dec;11(4):643-652.
doi: 10.1007/s12178-018-9523-y.

Evaluation and Management of Pyogenic and Tubercular Spine Infections

Barrett S Boody  1 , Daniel A Tarazona  2 , Alexander R Vaccaro  2
Affiliations
Review

Evaluation and Management of Pyogenic and Tubercular Spine Infections

Barrett S Boody et al. Curr Rev Musculoskelet Med. 2018 Dec.

Abstract

Purpose of review: To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection.

Recent findings: Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.

Keywords: Epidural abscess; Spine infection; Spondylodiscitis; Tuberculosis; Vertebral osteomyelitis.

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Conflict of interest statement

Conflict of Interest

Dr. Boody reports personal fees from Innovative Surgical Designs, outside the submitted work. The other authors declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Imaging shows skip lesions characteristic of TB spondylodiscitis with involvement of T6-7 and T11-12
Fig. 2
Fig. 2
Patient with gross kyphotic deformity due to spinal TB involving the lower thoracic spine
Fig. 3
Fig. 3
Forty-four-year-old with DM type 2 transfer presented with neck pain, arm weakness, and urinary incontinence with a diagnosis of C5-C6 spondylodiscitis (a). Follow-up imaging of the entire spine revealed a thoracic epidural (b) abscess extending down to the sacrum and L3-L4 spondylodiscitis (c). The patient underwent C5-C6 anterior cervical discectomy and fusion with autograft and C4-7 posterior cervical decompression and fusion with T4-S1 laminectomy (d). The patient later went back for an L3-L4 anterior lumbar interbody fusion and posterior lumbar instrumented fusion (e)
Fig. 4
Fig. 4
Multisegmental TB spondylodiscitis involving L1-3 with an epidural abscess causing spinal cord compression (left) and bilateral psoas abscess (right)
See this image and copyright information in PMC

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