Pyogenic spondylitis is very harmful, 4 types of people need to pay attention!

Author: Du Xinru, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Suppurative spondylitis is a purulent lesion on the spine. In layman's terms, it is a series of inflammatory changes caused by bacteria invading some structures of the spine.

Of course, this purulent lesion is often quite extensive, and in addition to the vertebral body, it can also affect other parts, such as the upper and lower end plates of the vertebral body, the intervertebral disc, and the surrounding structures of the spine.

1. Which groups of people are most likely to suffer from suppurative spondylitis?

It is most common in children and the elderly.

Because children's spines are not yet fully developed, they are more likely to get injured. Infection after injury may induce suppurative spondylitis, so children are one of the high-risk groups for suppurative spondylitis.

For the elderly, the main problem is that their resistance is relatively poor. When their resistance is very poor, some parasites in the body, such as conditional pathogens, may turn into pathogenic bacteria, thus causing the disease.

For example, many bacteria in the intestines are in a symbiotic state with us, such as Escherichia coli in the colon bacteria. Under normal circumstances, Escherichia coli is beneficial to us. It can help the human body synthesize vitamin K or help the human body absorb fat-soluble vitamins such as vitamin E.

However, when the body's resistance is reduced, these intestinal bacteria can penetrate the mucosal barrier and enter the blood system directly from the intestine, which can also cause spondylitis. This is called flora translocation. Originally, it should stay in the intestine, but it runs to other places to cause trouble, forming suppurative spondylitis, so the elderly are also a common group of people.

In addition, as our living standards improve, there are more and more diabetic patients. However, diabetic patients generally have low resistance, so they are also prone to infection.

There are also people who use corticosteroids or immunosuppressants, such as chemotherapy patients, who have poor resistance, so they may also develop suppurative spondylitis when they are infected with bacteria.

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2. What symptoms does suppurative spondylitis cause?

Generally, patients experience severe waist or back pain, which is unbearable and clearly located. This pain is often inconsistent with his lesions. Early X-rays sometimes do not show corresponding imaging manifestations, that is, no bone damage can be seen.

The second is spasm, the spasm of the lumbar muscles. After the muscle spasm, the patient dare not turn over or move, and even the legs are in a protective position, also called a forced position. He may not even be able to straighten his legs. In addition, there cannot be any vibration. Any vibration may cause his symptoms to be severely aggravated, so he may not be able to bear it even if he is touched slightly. This is a manifestation of inflammation itself.

In addition, there are secondary manifestations. If a psoas abscess is formed, it may compress the nerves and cause corresponding nerve irritation signs, such as leg numbness; if the nerve roots in the spinal canal are compressed, incontinence, sensory or motor disorders in both lower limbs may occur; especially after secondary spinal cord embolism, paraplegia may occur; some patients may also have meningitis, and central nervous system infection will be more serious.

Of course, fever is the most common symptom. Such patients often have a history of fever, with a body temperature above 38°C or even 39°C.

In addition, the patient may have some wasting symptoms, such as loss of appetite, malnutrition, weight loss, anemia, weak speech, etc.

Generally speaking, the patient's symptoms are divided into three parts: systemic manifestations, local manifestations and accompanying manifestations.

3. How to treat suppurative spondylitis?

The treatment of suppurative spondylitis is generally divided into two parts: conservative treatment and surgical treatment:

For conservative treatment, sensitive antibiotics should be selected based on the results of bacterial examination and drug sensitivity test. If sensitive antibiotics are not available, broad-spectrum antibiotics or those with strong antibacterial ability, such as third-generation cephalosporins and second-generation cephalosporins, should generally be selected. Combined use according to the situation is better for this disease.

Another thing is to improve nutrition, correct low protein and anemia, and actively treat the primary disease. Another thing is to rest in bed, and traction can be used when necessary, which is a systemic treatment.

Many mild cases, after treatment, the symptoms are significantly relieved, the bacteria are killed, the lesions are controlled, and the disease is cured.

However, some patients have already formed a stubborn lesion, and conservative treatment is not effective, so they need surgical treatment. The purpose of surgical treatment is drainage. Through surgery, a drainage tube is placed to let it flow out of the body and remove the inflammatory lesion.

Figure 2 Original copyright image, no permission to reprint

Another method is flushing. You can add a flushing tube locally and use some antibiotics to flush to achieve the purpose of local anti-inflammatory. In general, it is recommended to use gentamicin and saline for local flushing, but negative pressure drainage is required for local drainage.

While removing the lesions, if there is local bone destruction or defect, some bones can be implanted to rebuild the integrity of the spine. This is the general treatment plan for suppurative spondylitis.