Nonspecific pyoinflammatory diseases of the spine: spondylodiscitis and spinal epidural abscess

DOI: https://doi.org/10.29296/25877305-2019-10-02
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Issue: 
10
Year: 
2019

A. Yarikov(1–3), Candidate of Medical Sciences; Professor O. Perlmutter(1, 2), MD; I. Smirnov(1); Professor A. Fraerman(1), MD; Professor A. Mukhin(2), MD; A. Simonov(1), Candidate of Medical Sciences 1-City Clinical Hospital Thirty-Nine, Nizhny Novgorod 2-City Clinical Hospital Forty, Nizhny Novgorod 3-Volga District Medical Centre, Nizhny Novgorod

Nonspecific pyoinflammatory diseases of the spine remain relatively rare, difficult to diagnose, and severe. The urgency of the problems of their treatment is explained by the increase in their incidence, the emergence of new antibiotic-resistant bacterial strains, the severity of the course, and poor treatment outcomes. Spondylodiscitis (SPD) and spinal epidural abscess (SEA) are considered in detail. Their etiology, clinical presentation, and diagnosis have been thoroughly studied and are described. Current methods for diagnosing SPD and epiduritis, such as laboratory diagnosis, spondylography, computed tomography, magnetic resonance imaging, biopsy, scintigraphy, and positron emission tomography of the spine, are highlighted. Medical and surgical treatments for these vertebral infections are described in detail. An algorithm for their treatment is presented. Particular attention is paid to surgical treatment techniques for SPD and SER.
Keywords: 
infectious diseases
spondylodiscitis
spinal epidural abscess
spinal osteomyelitis
epiduritis
vertebral infection

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References: 
  1. Hafizova I.F., Popova N.A., Panjuhov A.G. i dr. Spondilodistsit: rannjaja diagnostika i taktika vedenija // Kazanskij meditsinskij zhurnal. – 2016; 97 (6): 988–93 [Khafizova I.F., Popova N.A. Panychov A.G. et al. Spondylodiscitis: early diagnosis and tactics of management // Kazanskij medicinskij zhurnal. – 2016; 97 (6): 988–93] (in Russ.)]. DOI: 10.17750/KMJ2016-988
  2. Herrero C., Nascimento A., Cunha R. et al. Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes // Coluna/Columna. – 2014; 13 (4): 294–7.
  3. Sans N., Faruch M., Lapegue F. et al. Infections of the spinal column — Spondylodiscitis // Diagn. Intervent. Imaging. – 2012; 93: 520–9.
  4. Guscha A.O., Semenov M.S., Poltorako E.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniju vospalitel'nyh zabolevanij pozvonochnika i spinnogo mozga / M.: Assotsiatsija nejrohirurgov Rossii, 2015; 23 s. [Gushcha A.O., Semenov M.S., Poltorako E.A. et al. Clinical guidelines for diagnosis and treatment of inflammatory diseases of the spine and spinal medulla / M.: Assotsiatsiya neyrokhirurgov Rossii, 2015; 23 r. (In Russ.)].
  5. Srinivas B., Sekhar D., Penchalayya G. et al. Post operative discitis – a review of 10 patients in a tertiary care neurosurgical unit // J. Dental. Med. Sci. – 2016; 15 (7): 1–4.
  6. Ardashev I.P., Ardasheva E.I. Vertebral'naja infektsija // Hirurgija pozvonochnika. – 2009; 2: 68–78 [Ardashev I.P., Ardasheva E.I. Vertebral infection // Hirurgiya pozvonochnika. – 2009; 2: 68–78 (in Russ.)].
  7. Dreval' O.N. Nejrohirurgija. T.2. / M.: GEOTAR-Media, 2013; s. 864 [Dreval O. N. Neurosurgery. Vol. 2 / M.: GEOTAR-Media, 2013; p. 864 (in Russ.)].
  8. Romanenkov V.M., Samoshenkov A.G. Ostryj gnojnyj spinal'nyj epidurit // Nejrohirurgija. – 2001; 4: 37–41 [Romanenkov V.M., Samochenkov A.G. Acute purulent spinal epiduritis // Nejrohirurgiya. – 2001; 4: 37–41 (in Russ.)].
  9. Snopko S.V., Firsov S.A., Kornilova I.V. i dr. Osobennosti diagnostiki i lechenija gnojnyh spinal'nyh epiduritov // Hirurgija pozvonochnika. – 2015; 12 (4): 84–7 [Snopko S.V., Firsov S.A., Kornilova I.V. et al. Peculiarities of diagnostics and treatment of purulent spinal epiduritis // Hirurgiya pozvonochnika. – 2015; 4: 84–7 (in Russ.)]. http://dx.doi.org/10.14531/ss2015.4.84-87.
  10. Goncharov M.Ju., Sakovich V.P., Danilov E.P. i dr. Blizhajshie rezul'taty lechenija gnojnyh nespetsificheskih zabolevanij pozvonochnika // Hirurgija pozvonochnika. – 2005; 2: 70–2 [Goncharov M.Y., Sakovich V.P., Danilov E.P. et al. Immediate results of treatment of purulent diseases of the spine // Hirurgiya pozvonochnika. – 2005; 2: 70–2 (in Russ.)].
  11. Goncharov M.Ju., Sakovich V.P., Levchik E.Ju. Spinal'nyj epidural'nyj abstsess. Sovremennye aspekty diagnostiki i okazanija spetsializirovannoj pomoschi // Ural'skij med. zhurn. – 2012; 5 (97): 67–70 [Goncharov M.Y. Sakovich V.P., Levchik E.Y. Spinal epidural abscess. Modern aspects of diagnosis and specialized care // Ural’skij medicinskij zhurnal. – 2012; 5: 67–70 (in Russ.)].
  12. Parfenov V.E., Martynov B.V., Fadeev B.P. i dr. Hirurgicheskaja infektsija v nejrohirurgii. V kn.: Sb. lektsij po aktual'nym voprosam nejrohirurgii, Sankt-Peterburg / SPb, 2008; s. 327–39 [Parfenov V.E., Martynov B.V., Fadeev B.P. et al. Hirurgicheskaya infekciya v nejrohirurgii. V knige: Sbornik lekcij po aktual’nym voprosam nejrohirurgii Sankt-Peterburg / St. Petersburg, 2008; pp. 327–39 (in Russ.)].
  13. Dulaev A.K., Manukovskij V.A., Shljapnikov S.A. i dr. Terapija otritsatel'nym davleniem pri gnojno-vospalitel'nyh oslozhnenijah posle hirurgicheskih vmeshatel'stv na pozvonochnike // Hirurgija pozvonochnika. – 2017; 14 (1): 78–84 [Dulaev A.K., Manukovsky V.A., Shlyapnikov S.A. et al. Negative pressure therapy in purulent-inflammatory complications after surgical interventions on the spine // Hirurgiya pozvonochnika. – 2017; 14 (1): 78–84 (in Russ.)]. http://dx.doi.org/10.14531/ss2017.1J8-84
  14. Lebedev V.V., Krylov V.V. Neotlozhnaja nejrohirurgija / M.: Meditsina, 2000; s 568 [Lebedev V.V., Krylov V.V. Neotlozhnaya nejrohirurgiya / M.: Meditsina, 2000; pp. 568 (in Russ.)].
  15. Protas R.N., Kubrakov K.M., Rihter A.V. Trudnosti diagnostiki spinal'nyh epiduritov // Vestnik VGMU. – 2004; 3 (2): 95–7 [Protas R.N., Kubrakov K.M., Richter V.A. Difficulties in the diagnosis of spinal epiduritom // Vestnik VGMU. – 2004; 2: 95–7 (in Russ.)].
  16. Goncharov M.Ju., Sakovich V.P. Hirurgicheskoe lechenie spinal'nyh epiduritov zadnej lokalizatsii // Acta Biomedica Scientifica. – 2011; 4: 38–9 [Goncharov M.Yu., Sakovich V.P. Surgical treatment of spinal epiduritom rear localization // Acta Biomedica Scientific. – 2011; 4: 38–9 (in Russ.)].
  17. Kubrakov K.M., Migunova V.A. Spondilodistsity: sovremennye podhody k diagnostike i lecheniju // Vestnik VGMU. – 2018; 17 (1): 14–22 [Kubrakov K.M., Migunova V.A. Spondylodiscitis: modern approaches to diagnosing and treatment // Vestnik VGMU. – 2018; 1: 14–22 (in Russ.)]. https://doi. org/10.22263/2312-4156.2018.1.14.
  18. Goncharov M.Ju., Sakovich V.P. Otsenka evoljutsii nevrologicheskih narushenij kak priznaka effektivnosti lechenija u patsientov s nespetsificheskimi gnojnymi zabolevanijami pozvonochnika // Saratovskij nauchno-med. zhurn. – 2012; 8 (2): 420–4 [Goncharov M.Y., Sakovich V. P. The evaluation of the evolution of neurological disorders as a sign of the effectiveness of treatment in patients with non-specific purulent diseases of the spine // Saratovskij nauchno-medicinskij zhurnal. – 2012; 8 (2): 420–4 (in Russ.)].
  19. Dulaev A.K., Manukovskij V.A., Kutjanov D.I. i dr. Tsentralizovannaja sistema okazanija spetsializirovannoj hirurgicheskoj pomoschi patsientam s ostroj netravmaticheskoj patologiej pozvonochnika v sovremennom megapolise // Hirurgija pozvonochnika. – 2017; 14 (2): 41–9 [Dulaev A.K., Manukovsky V.A., Kutyanov D.I., et al. A centralized system of specialized surgical care for patients with acute non-traumatic spine pathology in the modern metropolis // Hirurgiâ pozvonočnika. – 2017; 14 (2): 41–9 (in Russ.)]. https://doi.org/10.14531/ss2017.2.41-49.
  20. Goncharov M.Ju., Levchik E.Ju. Bolevoj vertebral'nyj sindrom kak kriterij effektivnosti hirurgicheskogo lechenija spondilitov u VICh-infitsirovannyh patsientov // Rossijskij zhurnal boli. – 2017; 1 (52): 64–5 [Goncharov M.Y., Levchik E.Y. Pain syndrome as a criterion of efficiency of surgical treatment of spondylitis in HIV-infected patients // Rossijskij zhurnal boli. – 2017; 1 (52): 64–5 (in Russ.)].
  21. Goncharov M.Ju., Levchik E.Ju., Sakovich V.P. Evoljutsija bolevogo vertebral'nogo sindroma kak kriterija effektivnosti hirurgicheskogo lechenija spondilitov u VICh-infitsirovannyh patsientov // Ross. zhurnal boli. – 2016; 2 (50): 90 [Goncharov M.Y., Levchik E.Y., Sakovich V.P. The Evolution of vertebral pain syndrome as a criterion for the effectiveness of surgical treatment of spondylitis in HIV-infected patients // Rossijskij zhurnal boli. – 2016; 2: 90 (in Russ.)].
  22. Goncharov M.Ju., Sakovich V.P., Levchik E.Ju. Nespetsificheskie gnojnye zabolevanija pozvonochnika kak prichina bolevogo sindroma v pozvonochnike // Rossijskij zhurnal boli. – 2014; 1 (42): 48–9 [Goncharov M.E., Sacovich V.P., Levchik E.Y. Non-specific diseases of the spine as a cause of pain syndrome in the spine // Rossijskij zhurnal boli. – 2014; 1: 48–9 (in Russ.)].
  23. Goncharov M.Ju., Levchik E.Ju. Hirurgicheskoe lechenie nespetsificheskih osteomielitov pozvonochnika u VICh-infitsirovannyh patsientov // VICh-infektsija i immunosupressija. – 2012; 4 (3): 62–5 [Goncharov M.Y, Levchik E.Y. Surgical treatment of non-specific spinal osteomyelitis in HIV-infected patients // VICH-infekciya i immunosupressiya. – 2012; 3: 62–5 (in Russ.)].
  24. Goncharov M.Ju., Sakovich V.P., Levchik E.Ju. Sindrom sistemnogo vospalitel'nogo otveta v hirurgicheskom lechenii nespetsificheskih gnojnyh zabolevanij pozvonochnika // Acta Biomedica Scientifica. – 2012; 4–2 (86): 39–42 [Goncharov M.Y., Sacovich V.P, Levchik E.Y. Syndrome of systemic inflammatory response in surgical treatment of non-specific purulent diseases of the spine // Acta Biomedica Scientifica. – 2012; 4–2 (86): 39–42 (in Russ.)].
  25. Karpov I.A., Gorbich Ju.L., Solovej N.V. i dr. Obzor klinicheskih rekomendatsij Amerikanskogo obschestva po infektsionnym boleznjam (IDSA) po diagnostike i lecheniju spondilitov u vzroslyh // Klin. mikrobiol. i antimikrobn. himioter. – 2017; 19 (3): 181–98 [Karpov I.A., Gorbich Yu.L., Solovey N.V. et al. A review of the Infectious Diseases Society of America (IDSA) guidelines on the diagnosis and treatment of spondylitis in adults // Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. – 2017; 19 (3): 181–98 (in Russ.)].
  26. Sheikh A. et al. Pathogen identification in suspected cases of pyogenic spondylodiscitis // Front. Cell. Infect. Microbiol. – 2017; 7: 60. https://doi.org/10.3389/fcimb.2017.00060
  27. Spira D. CT-guided biopsy in suspected spondylodiscitis -the association of paravertebral inflammation with microbial pathogen detection // PLoS One. – 2016; 11 (1): e0146399. DOI: 10.1371/journal.pone.0146399.
  28. Rehm J. et al. CT-guided percutaneous spine biopsy in suspected infection or malignancy: a study of 214 patients // Rofo. – 2016; 188 (12): 1156–62. DOI: 10.1055/s-0042-116233.
  29. Wu J., Gorbachova T., Morrison W. et al. Imaging-guided bone biopsy for osteomyelitis: are there factors associated with positive or negative cultures? // AJR Am. J. Roentgenol. – 2007; 188 (6): 1529–34. DOI: 10.2214/AJR.06.1286.
  30. Patel R., Vetter E., Harmsen W. Optimized pathogen detection with 30- compared to 20-milliliter blood culture draws // J. Clin. Microbiol. – 2011; 49 (12): 4047–51.
  31. Fraerman A.P., Perl'mutter O.A., Shahov A.V. i dr. Gnojnaja nejrohirurgija / Povolzh'e, 2015; s. 128 [Fraerman A.P., Perlmutter O.A., Shakhov A.V. et al. Gnojnaya nejrohirurgiya / Povolzh’e, 2015; p. 128 (in Russ.)].
  32. Petuhov V.I., Kubrakov K.M., Kornilov A.V. i dr. Osobennosti klinicheskih projavlenij i techenija gnojno-vospalitel'nyh zabolevanij pozvonochnika // Problemy zdorov'ja i ekologii. – 2018; 2 (56): 33–9 [Petukhov V.I., Kubrakov K.M., Kornilov A.V. et al. Features of clinical manifestations and course of inflammatory diseases of the spine // Problemy zdorov’ya i ehkologii. – 2018; 2 (56): 33–9 (in Russ.)].
  33. Narkulov M.S., Pardaev S.N., Karshiboev A.Zh. i dr. Tunnelizatsija pri pojasnichnyh spondilodistsitah // Meditsinskij al'jans. – 2017; 3: 84–8 [Narkulov M.S., Pardaev S.N., Karshiboev A.J., et al. Tunnelization with lumbar spondylodiscitis // Medicinskij al’yans. – 2017; 3: 84–8 (in Russ.)].
  34. Krotov G.O., Chernikov A.N., Beljachkov D.O. Abstsess perednego epidural'nogo prostranstva na urovne shejnogo otdela pozvonochnika // Rossijskij elektronnyj zhurnal luchevoj diagnostiki. – 2016; 6 (3): 128–32 [Krotov G.O., Chernikov A.N., Belyachkov D.O. Abscess of anterior epidural space at the level of the cervical spine // REJR. – 2016; 6 (3): 128–32 (in Russ.)]. DOI:10.21569/2222-7415-2016-6-3-128-132.
  35. Kulesh E.K., Antipova L.N., Beljaeva N.A. Spinal'nyj epidural'nyj abstsess: klinicheskij sluchaj // Nauchnyj vestnik zdravoohranenija Kubani. – 2017; 6 (54): 1–10 [Kulesh E.K., Antipova L.N., Belyaeva N.A. Spinal epidural abscess: clinical case // Nauchnyj vestnik zdravoohraneniya Kubani. – 2017; 6 (54): 1–10 (in Russ.)].
  36. Firsov S.A., Snopko S.V., Kornilova I.V. i dr. Gnojnye spinal'nye epidurity: skrytaja ugroza // Tihookeanskij meditsinskij zhurnal. – 2015; 4 (62): 92–4 [Firsov S.A., Snopko S.V., Kornilova I.V. et al. Purulent spinal epidurit: the phantom menace // Tihookeanskij medicinskij zhurnal. – 2015; 4 (62): 92–4 (in Russ.)].
  37. Kim D., Vaccaro A., Dickman C. et al. Surgical Anatomy and Techniques to the Spine, 2nd edition / Elsevier Inc., 2013.
  38. Haschin D.L., Redkoborodyj V.G., Poshechenkov A.P. Transpedikuljarnaja fiksatsija v hirurgicheskom lechenii tuberkuleznogo spondilita i hronicheskogo gematogennogo osteomielita pozvonochnika // Hirurgija pozvonochnika. – 2008; 4: 52–7 [Hachsin D.L., Redcoborodei V.G., Pochsechenkov A.P. Transpedicular fixation in surgical treatment of tuberculous spondylitis and chronic hematogenic osteomyelitis of the spine // Hirurgiya pozvonochnika. – 2008; 4: 52–7 (in Russ.)].
  39. Fursova L.A. Spondilodistsity v praktike nevrologa // Lechebnoe delo. – 2015; 4 (44): 57–61 [Fursova L.A. Spondylodiscitis in the practice of the neurologist // Lechebnoe delo. – 2015; 4: 57–61 (in Russ.)].
  40. Dulaev A.K., Alikov Z.Ju., Goranchuk D.V. i dr. Neotlozhnoe spetsializirovannoe lechenie nespetsificheskih infektsionnyh porazhenij pozvonochnika // Kafedra travmatol. i ortoped. – 2016; Spetsvyp.: 92 [Dulaev A.K., Alikov Z.Y., Goranchuk D.V. et al. Urgent specialized treatment non-specific infectious lesions of the spine // Kafedra travmatologii i ortopedii. – 2016; Special issue: 92 (in Russ.)].
  41. Gioev P.M., Kantemirova R.K. Ekspress-diagnostika zabolevanij pojasnichnogo otdela pozvonochnika u lits pozhilogo vozrasta // Uspehi gerontol. – 2009; 22 (3): 463–6 [Gioev P.M., Kantemirova R.K. Express diagnosis of diseases of the lumbar spine in the elderly // Uspekhi gerontologii. – 2009; 22 (3): 463–6 (in Russ.)].
  42. Ardashev I.P., Gatin V.R., Ardasheva E.I. i dr. Analiz hirurgicheskogo lechenija osteomielita pozvonochnika // Politravma. – 2013; 2: 22–9 [Ardashev I.P., Gatin V.R., Ardasheva E.I. et al. Analysis of surgical treatment of osteomyelitis of the spine // Politravma. – 2013; 2: 22–9 (in Russ.)].
  43. Ruf M., Stoltze D., Merk H. Treatment of vertebral osteomyelitis by radical debridement and stabilization using titanium mesh cages // Spine. – 2007; 32: 275–80.
  44. Ardashev I.P., Gatin V.R., Ardasheva E.I. i dr. Otdalennye rezul'taty konservativnogo lechenija osteomielita pozvonochnika // Vestnik novyh med. tehnol. – 2014; 21 (3): 108–11 [Ardashev I.P., Gatin V.R., Ardasheva E.I. et al. Long-term results of conservative treatment of osteomyelitis of the spine // Vestnik novyh medicinskih tekhnologij. – 2014; 21 (3): 108–11 (in Russ.)].
  45. Kosul'nikov S.O., Besedin A.M., Tarnapol'skij S.A. i dr. Nespetsificheskij gnojnyj osteomielit pozvonochnik // Medichnі perspektivi. – 2016; 21 (3): 41–6 [Kosulnikov S.O., Besedin A.M., Tarnapolski S.A. et al. Non-specific suppurative osteomyelitis of the spine // Medichnі perspektivi (Medicin, progress and prospects). – 2016; 21 (3): 41–6 (in Russ.)].
  46. Baulin I.A., Gavrilov P.V. Otsenka vlijanija razlichnyh faktorov na formirovanie perednego spondilodeza u patsientov, operirovannyh po povodu infektsionnogo spondilita // Molodoj uchenyj. – 2016; 27: 241–8 [Baulin I.A., Gavrilov P.V. Estimation of influence of various factors on the formation of anterior fusion in patients operated on for infectious spondylitis // Molodoj uchenyj. – 2016; 27: 241–8 (in Russ.)].
  47. Mushkin A.Ju., Kuklin D.V., Dorofeev L.A. i dr. Rekonstruktsija pozvonochnika pri rasprostranennyh polisegmentarnyh razrushenijah // Hirurgija pozvonochnika. – 2010; 3: 60–5 [MushkinA.Y., Kuklin D.V., Dorofeev L.A. et al. Reconstruction of the spine in the course of widespread destruction // Hirurgiya pozvonochnika. – 2010; 3: 60–5 (in Russ.)].
  48. Dekonenko E.P., Kuprijanova L.V., Tropihin I.M. i dr. Spinal'nyj epidural'nyj abstsess – klinicheskie osobennosti i slozhnosti differentsial'noj diagnostiki // Al'manah klinicheskoj meditsiny. – 2001; 4: 55–7 [Dekonenko E.P., Kupriyanova L.V., Tropihin I.M. et al. Spinal epidural abscess - clinical features and difficulties of differential diagnostics // Al’manah klinicheskoj mediciny. – 2001; 4: 55–7 (in Russ.)].
  49. Makogonova M.E., Mushkin A.Ju., Gavrilov P.V. Nevrologicheskij status i vizualizatsija spinnogo mozga u patsientov s infektsionnymi spondilitami: vozmozhny li sopostavlenija pri spondilogennoj mielopatii? // Obzory po klinicheskoj farmakologii i lekarstvennoj terapii. – 2017; 15 (2): 64–72 [Makogonova M.E., Mushkin A.Yu., Gavrilov P.V. Neurological status and imaging spinal cord in patients with infectious spondylitis: is it possible to comparisons with spondylogenic myelopathy? // Reviews on Clinical Pharmacology and Drug Therapy. – 2017; 15 (2): 64–72 (in Russ.)]. DOI: 10.17816/RCF15264-72.
  50. Boldin A.V., Martysh V.V., Agasarov L.G. Differentsial'naja diagnostika bolevogo sindroma v nizhnej chasti spiny i infektsionnyh porazhenij pozvonochnika v vertebro-nevrologicheskoj praktike na poliklinicheskom etape // Manual'naja terapija. – 2015; 4 (60): 43–7 [Boldin A.V., Martysh V.V., Agasarov L.G. Differential diagnosis of pain syndrome in the lower back and infectious lesions of the spine in the vertebro-neurological practice at the polyclinic stage // Manual’naya terapiya. – 2015; 4: 43–7 (in Russ.)].
  51. Grin' A.A., Kajkov A.K., Ioffe Ju.S. i dr. Uspeshnoe hirurgicheskoe lechenie bol'noj s tuberkuleznym spondilitom // Nejrohirurgija. – 2011; 3: 68–72 [Grin A.A., Kaykov A.K., Ioffe Y.S. et al. Successful surgical treatment of patient with tuberculous spondylitis // Nejrohirurgiya. – 2011; 3: 68–72 (in Russ.)].
  52. Dulaev A.K., Manukovskij V.A., Kutjanov D.I. i dr. Diagnosticheskaja i lechebnaja taktika pri okazanii spetsializirovannoj meditsinskoj pomoschi bol'nym s zabolevanijami pozvonochnika v uslovijah otdelenija neotlozhnoj hirurgicheskoj vertebrologii // Genij ortopedii. – 2017; 23 (4): 429–38 [Dulaev A.K., Manukovsky V.A., Kutanov D.I. et al. Diagnostic and therapeutic tactics in the provision of specialized medical care for patients with diseases of the spine in the conditions of the separation of urgent surgical spine // Genij ortopedii. – 2017; 23 (4): 429–38 (in Russ.)]. DOI: 10.18019/1028-4427-2017-23-4-429-438.