Non-tuberculous infections of the spine
Beguiristáin J.L., Villas C., Garbayo A.
Dpto. de Cirugía Ortopédica y Traumatología, Universitaria Facultad de Medicina, Universidad de Navarra, Pamplona
Non tuberculous spondylodiscitis of the rachis is an uncommon entity that affects boys and male adults with greater frequency. The zone with higher incidence of affection is the lumbar region. Usually the causal germ travels through the hematogenous via from an extrarachidial infectious area.
Clinical manifestations begin with an acute segmentary rachialgia and paravertebral muscular contracture while presenting fever. In special cases of little boys or when having radiated pain, the presenting form could be confusing. There is always a vertebral rigidity when performing the physical exam and an increase of the globular sedimentation rate. A septic leukocytal formula is not always present. Between the onset of symptoms and the appearance of radiologic alterations (decrease in the height of the disc, erosion and vertebral destruction, reactive bone neo-formation) there is a variable two to eight weeks latency period. Scintigraphy with Tc99 and Ga67 and CAT scan are very important when facing definite diagnosis.
To be able to reach a bacteriological diagnosis, we employ puncture-aspiration of the disc. The isolated germ in most cases is staphylococcus aureus. The most complex differential diagnosis is with tuberculous spondylodiscitis. The evolution is favorable if the treatment is initiated early and if it is adequate (antibiotic therapy and immobilization).
If this is not done, recurrences and chronicity of the infection can occur, as well as orthopaedic (Kyphosis) and neurological complications.
CITA DEL ARTÍCULO Rev Med Univ Navarra. 1987 Jul-Sep;31(3):149-52, 155-6, 159-61