ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
Spondylodiscitis is an inflammatory disorder of the vertebrae and intervertebral discs. It is caused by bacteria or fungi. Risk factors for developing spondylodiscitis include diabetes, alcohol/drug abuse, hemodialysis, suppressed immunity etc. Spondylodiscitis may affect the stability of the spine and cause spinal cord and nerve root compression.
A drawing of a sagittal section of a lumbar spinal spondylodiscitis
CAUSE OF SYMPTOMS
Acute compression of the spinal cord and/or nerve roots
Bacterial inflammation of the vertebrae and intervertebral discs
SYMPTOMS AND SIGNS
Severe back pain above the inflammation
Pain in limbs
Total/partial paralysis and numbness from the site of the spinal cord damage downwoads
THE DIAGNOSIS IS BASED ON Medical history Clinical exam
Blood tests Magnetic resonance imaging (MRI) Blood cultures
additionally you may have to do:
Biopsy Computer tomography
Approximately 90% of cases can be treated conservatively. In the absence of spinal cord/nerve root compression and lack of data on instability of the inflamed segment, conservative treatment with:
Non-surgical treatment may include Antibiotics
Empirical treatment should start AFTER biopsy material for microbiological testing is obtained (PMID: 27082590
). The following empirical treatment may be administered for a total of 6 weeks (PMID: 26872859
- Ceftriaxone 2x2g and Clindamycin 3x600mg i.v. for 2 weeks
- Ciprofloxacin 2x500mg and Clindamycin 4x300mg p.o. for 4 more weeks
If the pathogen can be identified - antibiotic treatment should be adapted to the susceptibilities of the microorganism.
WHEN SHOULD AN OPERATION BE PERFORMED?
Neurological symptoms caused by compression of the spinal cord or nerve roots
The stability of the spine is compromised
WHAT IS THE GOAL OF SURGERY?
Obtaining material for histological examination
To release the compressed nerve roots and/or spinal cord
To restore the protective function of the spine
HOW IS SURGERY PERFORMED?
Posterior spinal canal decompression
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Bleeding in the spinal canal Tumor of the spine Vertebral fractures Spinal abscess