Spinal infection [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Spinal infection ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1bmzyevNxekuWJ5GrBRxTCVcKIkiv5P9XRtzZ2hokRhVtTDQFT/?limit=15&utm_campaign=pubmed-2&fc=20240213070305}}

===== Epidemiology =====
[[Surgical site infection]]s are the second most common health care-associated infection in the United States, representing 22% of all such infections 
((Kang DG, Holekamp TF, Wagner SC, et al. Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: A systematic literature review. Spine J 2015;15:762–770 )).

In spine surgery, the incidence of postoperative wound infection is 0.7 to 16% 
((O'Toole J E, Eichholz K M, Fessler R G. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11(4):471–476.))
((Schimmel J J, Horsting P P, de Kleuver M, Wonders G, van Limbeek J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010;19(10):1711–1719)).

The mean age at presentation was 57.1 ± 13.5 years
((Bydon M, De la Garza-Ramos R, Macki M, Naumann M, Sciubba DM, Wolinsky JP,
Bydon A, Gokaslan ZL, Witham TF. Spinal Instrumentation in Patients with Primary 
Spinal Infections Does Not Lead to Greater Recurrent Infection Rates: An Analysis
of 118 Cases. World Neurosurg. 2014 Jun 14. pii: S1878-8750(14)00560-9. doi:
10.1016/j.wneu.2014.06.014. [Epub ahead of print] Review. PubMed PMID: 24937598.)).

===== Classification =====

see [[Spinal infection classification]].

===== Etiology =====
Spinal infections can be described aetiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic.

Pyogenic spinal infections include: [[spondylodiscitis]], a term encompassing [[vertebral osteomyelitis]], [[spondylitis]] and [[discitis]], which are considered different manifestations of the same pathological process; [[spinal epidural abscess]], which can be primary or secondary to spondylodiscitis; and facet joint arthropathy
((Hadjipavlou AG, Mader JT, Necessary JT et al. Hematogenous pyogenic spinal infections and their surgical management.Spine  (Phila  Pa  1976) 2000;25: 1668–79.)).

===== Risk factors =====

[[Spinal infection risk factors]]




===== Diagnosis =====

==== Physical examination ====

Findings that suggest this as a possibility (but are also common in patients without [[infection]])

Fever: common in [[spinal epidural abscess]] and [[vertebral osteomyelitis]], less common in discitis 

Vertebral tenderness

Very limited range of spinal motion.

==== Spinal epidural abscess diagnosis ====

see [[Spinal epidural abscess diagnosis]].


===== Treatment =====

see [[Spinal infection treatment]].

===== Delphi consensus studies =====

The de novo non-specific [[spinal infection management]]s ([[spondylodiscitis]] - SD) remains inconsistent due to varying clinical practices and a lack of high-level [[evidence]], particularly regarding the indications for surgery.

[[Research question]]: This study aimed to develop [[consensus]] [[recommendation]]s for [[spondylodiscitis diagnosis]] and [[spondylodiscitis management]], addressing diagnostic modalities, surgical indications, and [[spondylodiscitis treatment]] strategies.

A [[Delphi]] process was conducted with 26 [[expert]]s from the [[European Association of Neurosurgical Societies]] ([[EANS]]). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts.

Consensus was reached on 38 of 62 statements. [[MRI]] was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. [[Motor deficit]]s with a motor score (MRC) below 4 and [[bladder]] or [[bowel]] [[dysfunction]] were unanimously considered clear indications for surgery. For [[spinal deformity]] and [[instability]], thresholds such as [[kyphosis]] >20°, [[scoliosis]] >10°, and vertebral body [[collapse]] >50% were established to guide surgical [[decision-making]]. [[Minimally invasive surgery]] (MIS) was endorsed whenever feasible, and a 12 week [[antibiotic]] treatment regimen was favored in cases of complicated infections.

This EANS consensus provides updated [[recommendation]]s for [[spondylodiscitis management]], incorporating recent [[evidence]] on improved outcomes with surgical therapy. While these [[guideline]]s offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies
((Kramer A, Thavarajasingam SG, Neuhoff J, Davies B, Barbagallo G, Debono B, Depreitere B, Eicker SO, Gabrovsky N, Gandia-Gonzalez ML, Ivanov M, Kaiser R, Kaprovoy S, Konovalov N, Lafuente J, Maciejczak A, Meyer B, Pereira P, Petrova Y, Peul WC, Reizinho C, Ryang YM, Sampron N, Schär R, Tessitore E, Thomé C, Timothy J, Vleggeert-Lankamp C, Demetriades AK, Shiban E, Ringel F. Diagnosis and management of de novo non-specific [[spinal infection]]s: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations. Brain Spine. 2024 Dec 31;5:104178. doi: 10.1016/j.bas.2024.104178. PMID: 39866360; PMCID: PMC11763570.)).


====Case series====
----
An observational, prospective study was conducted of the rates of surgical wound infection among patients admitted for more than 48 h to the Neurosurgery Department of  Ramon y Cajal University Hospital , Madrid , Spain (a tertiary-level university hospital) between July 2011 and December 2014.

The study surveyed a total of 536 surgical procedures performed in 521 patients. The rate of diagnosed surgical site infection (SSI) was 4.85% (26 infections), below the established acceptable threshold of 5%. Of these, 65.38% were organ-space infections, 30.77% deep infections, and 7.69% superficial infections. Infection rates for each type of surgical procedure were 4.35% for spinal fusion, 0.00% for refusion of spine, 2.08% for laminectomy, 5.95% for ventricular shunt, and 5.14% for craniotomy. Antibiotic prophylaxis was evaluated as suitable in 80.22% of surgical procedures.

Infection rates were lower when the surgery was elective, clean, the patient had a lower ASA, and when suitable antimicrobial prophylaxis was administered. The rate of suitable antimicrobial prophylaxis shows that there is room for improvement. In order to minimize the risk of surgical wound infection, all professionals involved in patient care need to know and apply current recommendations, especially those relating to proper hand hygiene and suitable antibiotic prophylaxis
((López Pereira P, Díaz-Agero Pérez C, López Fresneña N, Las Heras Mosteiro J,
Palancar Cabrera A, Rincón Carlavilla ÁL, Aranaz Andrés JM. 'Epidemiology of
surgical site infection in a neurosurgery department'. Br J Neurosurg. 2016 Dec
1:1-6. [Epub ahead of print] PubMed PMID: 27905216.
)).