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Dr. Paresh Bang
Consultant Spine Surgeon
Surgery For Spine Infections In Chandrapur
Surgery For Spine Infections
Spinal osteomyelitis or spondylodiscitis is an infection of the spine that has come to consider surgery, usually after other treatments such as antibiotics have failed to control the infection or complications. Infection may be limited to the vertebrae, intervertebral discs, and soft tissue around the spine. Early treatment is essential to prevent possible serious consequences: spinal deformity, neurological damage, or sepsis.
Spinal Infection Surgery will attempt to remove or relieve the pressure on the spine or spinal nerves and help to remove as much of the infection as possible. Removing a majority, if not all, of the infection will help prevent reoccurrence and allow antibiotics to kill off remaining toxicity.
Indications for Surgery:
Surgery for spinal infections is generally considered in the following situations:
- Neurological Deficits: If the infection causes compression of the spinal cord or nerves, leading to symptoms like weakness, numbness, or paralysis, surgical decompression is necessary to prevent permanent damage.
- Spinal Instability:When infection erodes the bones of the spine (vertebrae), it can lead to spinal instability or deformity, risking further damage to the spinal cord or nerves. In such cases, surgical stabilization with instrumentation (e.g., rods, screws) is required to support the spine.
- Abscess Formation:The infection can lead to the formation of epidural or paraspinal abscesses, which can press on the spinal cord or nerve roots. Drainage of these abscesses through surgery may be necessary to relieve pressure and reduce the risk of neurological injury.
- Failure of Medical Management:If a patient does not respond to appropriate antibiotic therapy or if the infection is progressing despite treatment, surgery may be necessary to remove infected tissues and improve the effectiveness of antibiotics.
- Severe Pain:Intractable pain that doesn’t respond to non-surgical treatments may require surgical intervention to relieve pressure, stabilize the spine, or address complications of the infection.
Types of Surgical Procedures:
Several types of surgical interventions are performed depending on the location, extent of the infection, and its complications
Debridement:
- The infected and necrotic (dead) tissue, including infected bone and disc material, is removed in a procedure called debridement. This helps in controlling the infection and allows healthy tissue to heal.
Decompression:
- In cases where the infection has caused compression of the spinal cord or nerves, a decompression procedure may be performed. This involves removing parts of the infected bone or disc that are pressing on the spinal cord.
Spinal Fusion or Instrumentation:
- If the infection has caused significant bone destruction and spinal instability, spinal fusion may be performed. This procedure involves placing bone grafts between the affected vertebrae to promote healing and stabilization. Instrumentation such as rods ,screws be used to maintain stability with the spine heals.
Abscess Drainage:
- Surgical drainage is often necessary when there are large abscesses (pockets of pus) in the spine or surrounding areas. This can be done either through open surgery or minimally invasive techniques, depending on the size and location of the abscess.
Minimally Invasive Surgery (MIS):
In some cases, minimally invasive approaches can be used to drain abscesses, perform biopsy, or remove infected tissue. These techniques offer the advantage of smaller incisions, reduced recovery time, and less post-operative pain.
Surgical Treatment
Nonsurgical treatment should be considered first when patients have minimal or no neurological deficits and the morbidity and mortality rate of surgical intervention is high. However, surgery may be indicated when any of the following situations are present:
Significant bone destruction causing spinal instability
- Neurological deficits
- Sepsis with clinical toxicity caused by an abscess unresponsive to antibiotics
- Failure of needle biopsy to obtain needed cultures
- Failure of intravenous antibiotics alone to eradicate the infection
Types of Spine Infections
- Vertebral Osteomyelitis: Infection of a bones in the spine (vertebrae).
- Discitis: Infection of the intervertebral discs.
- Spinal Epidural Abscess: Accumulation of pus between the dura mater (the outer membrane covering the spinal cord) and the spine.
- Post-surgical Infections: Infections that arise after spinal surgeries.
Post-Surgery Care:
After surgery for a spinal infection, post-operative care is essential for recovery and to prevent recurrence of the infection.
- Antibiotic Therapy: Surgery is almost always followed by a prolonged course of intravenous (IV) or oral antibiotics, typically lasting for 6 to 12 weeks or longer, depending on the type of infection and the patient’s response to treatment. Antibiotics are selected based on the culture of the infected tissue.
- Wound Care:The surgical wound is monitored carefully to prevent post-operative infections. Dressings are changed regularly, and the wound is kept clean and dry.
- Pain Management:Pain relief is provided with medications, and patients may gradually transition from stronger painkillers (like opioids) to non-steroidal anti-inflammatory drugs (NSAIDs).
- Physical Therapy:Rehabilitation is crucial after surgery to restore mobility, strengthen the spine, and improve overall function. Depending on the extent of the surgery, patients may need physical therapy to regain movement and strength in their back, legs, and core muscles.
- Monitoring for Complications:Regular follow-ups with imaging (X-rays, CT scans, or MRIs) will be necessary to ensure that the infection has cleared, the spine is stable, and no new abscesses have formed. Blood tests may also be done to monitor inflammation and infection markers (like C-reactive protein and white blood cell count).
Potential Complications of Surgery:
While surgery for spinal infections can be life-saving, it is not without risks. Potential complications include:
- Recurrence of Infection: Despite surgery and antibiotics, there’s a risk that the infection could return, particularly if not all infected tissue was removed or if antibiotic therapy was not completed properly.
- Neurological Damage: While surgery aims to decompress the spinal cord or nerves, there is a risk of neurological injury during the procedure, which can result in worsening symptoms like paralysis or sensory loss.
- Spinal Instability or Deformity: If extensive debridement is required, it may weaken the spine, leading to instability or deformities such as kyphosis (a forward curve of the spine).
- Hardware Complications:If spinal instrumentation is used, there is a risk that screws, rods, or plates may loosen, break, or become infected.
Non-Union or Delayed Healing:
If spinal fusion is performed, there’s a risk that the bone graft may not heal properly (non-union), leading to instability or the need for further surgery.
Surgical Approaches
- Debridement: Removal of infected or necrotic tissue.
- Drainage: Abscesses may need to be drained to relieve pressure on the spinal cord.
- Spinal Fusion: If infection has caused instability, spinal fusion may be performed to provide stability by fusing two or more vertebrae together.
- Laminectomy: Removal of part of the vertebra to relieve pressure on the spinal cord and nerves.
- Percutaneous Surgery: In some cases, minimally invasive procedures can be performed to drain abscesses or inject antibiotics.
Non-surgical Treatment
Not all spine infections require surgery. Mild infections may be treated with:
- Antibiotics: Typically administered intravenously for several weeks.
- Immobilization: Use of braces to limit movement and support the spine during healing.
Recovery Timeline:
- Hospital Stay: Patients may stay in the hospital for several days to weeks, depending on the complexity of the surgery and their overall health.
- Short-Term Recovery: Initial recovery takes a few weeks to months. Patients will need to avoid strenuous activities and may need assistance with walking or moving.
- Long-Term Recovery: Full recovery, including spinal fusion and resolution of the infection, may take several months to a year. Physical therapy is often required to restore full function.Contact Us
Prognosis
Early diagnosis and treatment (both surgical and non-surgical) are crucial for a good outcome. Delayed treatment may lead to complications such as chronic pain, permanent neurological deficits, or spinal deformity.Visit Our Hospital