Infections of the vertebral bodies (spondylitis) and/or the discs (spondylodiscitis) lead to the destruction of the infected tissue as well as the affected bony structures. Purulent bacterial inflammation is most commonly caused by staphylococci. Disease pathogens enter the bloodstream or directly, e.g. after surgery spine. Pain and instability are frequently the result of pus accumulation (abscesses) that is left untreated, and can cause neurological deficits. Longer periods of being bedridden or life-threatening general inflammation (sepsis) must be avoided.
The first and foremost step in diagnosis is to determine the causative pathogen. In this case, a tissue sample is taken and microbiologically examined. If the pathogen is known, a targeted antibiotic treatment is applied. Immobilization of the affected spine segments, e.g. with a corset or cast, is essential. Surgery may be necessary to remove infected tissue or the local accumulation of pus, as seen in the following patient example:
The patient is 75 years old. His general health is poor. He is a diabetic and has been struggling with a non-healing wound (ulcer) on the foot over the last months. Since the last 6 weeks, he feels very sick and also suffers from severe pain in the small of his back; he is bedridden because of the pain. The local general practitioner has arranged for the patient to receive treatment in a hospital situated near the patient’s home. Although inflammation of the disc and vertebral body (L4-5 level) is diagnosed and treated with antibiotics, the patient’s condition worsens.
The spinal column has become unstable and larger amounts of pus have accumulated within the disc space (Fig. 9.1), which must be removed. The abscess together with the infected disc and damaged bone are removed, and the remaining area is thoroughly rinsed. A piece of stable, healthy bone can then be used to fill the resulting defect. Finally, screws and rods are inserted into the adjacent intact vertebra or vertebral body parts via a tissue-preserving, minimally invasive approach (Fig. 9.2). In this way, adequate stability is ensured to promote healing, so that the patient can get up again immediately after the operation and targeted antibiotic therapy can be continued for a further 6-12 weeks.