Clinical manifestations of suppurative spondylitis

Pyogenic spondylitis is mainly caused by hematogenous infection. At this time, the bacteria will reach the diseased part through the blood, often causing the patient to have symptoms such as high fever, chills, vomiting, nausea, coma, etc. More serious cases can lead to systemic poisoning, often causing severe pain in the waist, and the patient cannot turn over. Severe cases may even cause limb paralysis.

Symptoms and signs

1. Acute systemic poisoning symptoms or subacute manifestations such as chills, high fever, confusion, coma, vomiting, and abdominal distension.

2. Severe pain in the waist, inability to turn over, groaning and restless. Physical examination revealed tenderness of the spinous processes, local percussion pain, and spinal stiffness.

3. Signs of nerve root irritation within the spinal canal such as segmental radiating pain, muscle spasm, etc. Paralysis of limbs.

Diagnostic tests

1. Pay attention to the age, gender, and site of onset. The patients were asked whether they had a history of furuncle, carbuncle, tonsillitis or urinary system inflammation before the onset of the disease, and whether they had a history of spinal or intervertebral disc surgery or open injury.

2. Inquire in detail and observe the onset of the disease to see if there are any symptoms of acute systemic poisoning or subacute manifestations such as chills, high fever, confusion, coma, vomiting, and abdominal distension.

3. Pay special attention to local symptoms, such as severe pain in the waist, inability to turn over, and groaning and restlessness. The physical examination was conducted to check for tenderness of the spinous processes, local percussion pain, and spinal stiffness.

4. Whether there are signs of intraspinal nerve root irritation such as segmental radiating pain, muscle spasm, etc. Whether there is limb paralysis.

5. X-rays show whether there is vertebral osteoporosis, whether the edges are blurred, whether the intervertebral space is narrowed, as well as vertebral sclerosis, intervertebral bone bridge formation and vertebral fusion.

6. White blood cell count and classification, erythrocyte sedimentation rate, and bacterial culture of blood and pus.

Treatment options

1. Use large doses of antibiotics in combination at an early stage and make timely adjustments based on the results of bacterial culture and drug sensitivity tests. After one month of intravenous administration, switch to oral administration until the symptoms disappear and the erythrocyte sedimentation rate returns to normal. Strengthen supportive therapy (nutrition, infusion, blood transfusion, correction of water and electrolyte disorders).

2. During the acute phase, the patient should strictly stay in bed. Depending on the situation, a plaster bed or a plaster waist belt can be used for fixation. The fixation period should generally not be less than 3 months or until the ESR returns to normal.

3. Surgical treatment is limited to:

① Neurological symptoms progressively worsen;

② Obvious bone destruction, spinal deformity and instability;

③ Large abscess formation;

④ Recurrence of infection;

⑤Conservative treatment is ineffective.