Osteomyelitis

Osteomyelitis is an infection of the bone normally caused by bacteria. The infection is developed by blood carrying organisms. In relation with spine, it is normally present in the vertebrae, but the infection can disperse into the epidural and intervertebral disc spaces. There are two forms of osteomyelitis, acute and chronic.

1. Acute Osteomyelitis: Staphylococcus aureus bacteria are usually the cause of this type; microorganism may pass into the bloodstream through a wound or infected intravenous needle.
2. Chronic Osteomyelitis: It may increase gradually enhanced by tuberculosis, AIDS, and similar conditions that compromise immunity. Infection of bone is co-induced by blockage of blood vessels, which brigs upon death of living cells in bones and local spread of infection. Infection can also spread through the bone cortex and under the dense fibrous membrane covering the surface of bones, with formation of abscesses located below the epidermis. The abscess may drain without apparent external cause through the skin.

It does not spread to the other parts of the body normally, mainly due to the reason that they are alive and have a blood supply and the immune system is promptly working to protect from infection.

Osteomyelitis is not contagious and cannot harm other people in the environment if they are not debilitated. Osteomyelitis is more frequent in young children and the elderly, but it can appear at any age.

Symptoms & Signs

People suffering from osteomyelitis of the outer area of bones, are usually characterized by fever, experience weight loss and fatigue, and have warmth restricted to diseased location, swelling, redness of the skin resulting from dilation of blood vessels and tenderness.

Vertebra Osteomyelitis causes back pain in the diseased location with paravertebral muscle spasm that is not responsive to the standard treatment. Patients are usually having no fever.
Acute osteomyelitis is only in a part treated successfully, low-grade chronic osteomyelitis increases with duration ranging from months to many years, with bone pain, tenderness, and sinus drainage.

The symptoms show continuous and intense back pain, and it is greatly increased by movement, accompanied with swelling, fever, sweating, weight loss, and mild sickness or depression.
Abdominal pain and acute spasmodic pain along the course of one or more nerves may be initiated by the lumbar spine infection. If the infection attacks the epidural space, severe back pain may come with radicular pain, weakness and sometimes paralysis follows.

Diagnosis

In case of infection, prompt treatment is required especially because of possible neurologic shortage. An x-ray can show the location of the infection, alterations in the bone, and loss of intervertebral disc height.

Localized bone pain, fever and mild sickness or depression suggests osteomyelitis. X-rays become abnormal after 3 to 4 wk, pointing bone destruction, soft tissue swelling, periosteal elevation, loss of vertebral body height or narrowing of the adjacent infected intervertebral disk space, and destruction of the end plates above and below the disk.

If x-rays are equivocal, than CT scan can clarify the abnormality and show paravertebral abscess formation. Bone biopsy with a needle or surgical removal of the part or tissue and aspiration or debridement of abscesses is helpful.

If an abscess is present, a procedure called percutaneous needle aspiration may be done to collect a sample of the infection for identification. When needle biopsy is insufficient, than open biopsy is surgically done, this may require surgical removal of foreign material and dead tissue from the wound in order to prevent infection and promote healing.

Treatment

Spinal infections normally go without surgery. Intravenous antibiotics are given in the hospital and may be continued at home for up to 3 months. Oral antibiotics may need to be taken for several months. Antibiotics should be selected to cover gram-positive and gram-negative organisms until culture results are at hand. But surgery may be needed after all to drain a paravertebral or epidural abscess or to strengthen the spine to forestall injury. Skin or pedicle grafts may be needed to close large surgical defects.

A medicine and bracing can be used to relieve and control the pain. Surgery can be opted if antibiotic treatments fail to produce improvement, or neurologic deficit presents, deformity progresses, or infected bone or tissue removal is required.

Free Tissue Transfers: Tissue or bone is displaced from another part of the body to reconstruct the extremity. Bone or muscle is displaced with its blood supply (artery and vein) and re-bonded again to supply healthy tissue to assist healing at the old site of the infection. The tissue moved serves a new purpose.

Bone Grafts: Bone grafts are acquired to fill defects in bones or to help the ends of bones to heal together. Normally it’s the marrow is used from the bone. Bone graft most of the time comes either from the back of the pelvis or from the tibia. Each site yields a different amount of graft. The site used is based on how much bone is needed. Bone Graft Substitutes are bone (donor) or bone-like substances which, when implanted, work like grafts taken from the same body.

External Fixators: The metallic devices used outside the skin to give the bone some extra strength, while it heals. Pins pass from the device, through the skin and into the bone. It is only used for a short time; just enough to hold bones in place until healing is complete.

Amputations: Are recommended in particular situations to refrain from putting a patient through further surgery, which is considered unnecessary. Amputations in those circumstances are regarded as good treatment options rather than as failures.