Pyogenic and Non-Pyogenic Spinal Infections: Diagnosis and Treatment

Nandan Amrit Marathe, Giuseppe Tedesco, Annamaria Chiesa, Abhinandan Reddy Mallepally, Maddalena Di Carlo, Riccardo Ghermandi, Gisberto Evangelisti, Marco Girolami, Valerio Pipola, Alessandro Gasbarrini

Research output: Contribution to journalArticlepeer-review

Abstract

Spinal infection (SI) is an infection of vertebral bodies, intervening disc, and/or adjoining para-spinal tissue. It represents less than 10 % of all skeletal infections. There are numerous factors that predispose to developing a SI. Due to the low specificity of signs, delayed diagnosis is common. Hence, SI may be associated with poor outcomes. Diagnosis of SI must be supported by clinicopathological and radiological findings. MRI is a reliable modality of choice. Treatment options vary according to the site of the infection, disease progression, neurology, presence of instability, and general condition of the subject. Conservative treatment (orthosis/ bed-rest + antibiotics) is recommended during the early course with no/ lesser degree of neurological involvement and to medically unfit patients. Nevertheless, when conservative measures alone fail, surgical interventions must be considered. The use of concomitant antimicrobial drugs intravenously during initial duration followed by oral administration is a necessity. Controversies exist regarding the optimal duration of antimicrobial therapy, yet never given less than six weeks. Heterogeneity in clinical picture and associated co-morbidities with a range of treatment modalities are available; however, a common applicable guideline for SI does not exist. Managing SI must be tailored on a case-to-case basis.

Original languageEnglish
Pages (from-to)231-241
Number of pages11
JournalCurrent Medical Imaging
Volume18
Issue number2
DOIs
Publication statusPublished - 2022

Keywords

  • Spinal infection
  • diagnosis
  • pyogenic
  • spondylitis
  • treatment
  • spondylodiscitis
  • tuberculosis

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