ABSTRACT
Las infecciones espinales son cuadros clínicos poco frecuentes, que exigen un alto índice de sospecha. La prevalencia de infecciones piógenas de la columna ha ido en aumento, en parte debido al envejecimiento de la población y a un mayor número de pacientes inmunocomprometidos. El estudio imagenológico se puede iniciar con radiografías simples, pero la resonancia magnética es el examen imagenológico de elección, ya que puede dar resultados positivos de forma precoz, entregando información más detallada del compromiso vertebral y tejidos blandos adyacentes. Aunque la clínica y los hallazgos imagenológicos nos pueden orientar, es importante intentar un diagnóstico microbiológico tomando cultivos y muestras para identificar al agente causal antes de iniciar los antibióticos; aunque es óptimo un tratamiento agente-específico, hasta un 25% de los casos queda sin diagnóstico del agente. El tratamiento es inicialmente médico, con antibióticos e inmovilización, pero se debe considerar la cirugía en casos de compromiso neurológico, deformidad progresiva, inestabilidad, sepsis no controlada o dolor intratable. El manejo quirúrgico actual consiste en el aseo y estabilización precoz de los segmentos vertebrales comprometidos. Descartar una endocarditis concomitante y el examen neurológico seriado son parte del manejo de estos pacientes.
Spinal infections are unusual conditions requiring a high index of suspicion for clinical diagnosis. There has been a global increase in the number of pyogenic spinal infections due to an aging population and a higher proportion of immunocompromised patients. The imaging study should start with plain radiographs, but magnetic resonance imaging (mri) is the gold standard for diagnosis. Mri can detect bone and disc changes earlier than other methods, and it provides detailed information on bone and adjacent soft tissues. Blood cultures and local samples for culture and pathology should be obtained, trying to identify the pathogen. According to the result, the most appropriate drug must be selected depending on susceptibility and penetration into spinal tissues. Treatment should start with antibiotics and immobilization; surgery should be considered in cases with neurological impairment, progressive deformity, spine instability, sepsis, or non-controlled pain. Current surgical treatment includes debridement and early stabilization. Practitioners should rule out endocarditis and perform a serial neurological examination managing these patients.
Subject(s)
Humans , Spinal Diseases/diagnosis , Spinal Diseases/microbiology , Spinal Diseases/therapy , Prognosis , Spinal Diseases/physiopathology , Spine/microbiology , Spondylitis/diagnosis , Spondylitis/therapy , Discitis/diagnosis , Discitis/therapy , Epidural Abscess/diagnosis , Epidural Abscess/therapyABSTRACT
The aim of this study was to describe the imaging features of multilevel brucellar spondylitis and discuss the diagnostic challenges The authors report describes one case of noncontiguous synchronous multifocal involvement of thoracic and lumbar spine. Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, but multilevel involvement is uncommon and only ten cases were reported in literature. Although it is an exceptional form, multifocal brucellar spondylitis is worth to be known to avoid diagnostic mistakes