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PYOGENIC VERTEBRAL
OSTEOMYELITIS
› LevelVertebralInectin
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INFECTING ORGANISM

›Staph.aureus  M/Crganism
›Gramneg. 
E.cli,P.aeruginsa,Klebsiella
›Anaerbic rare
›mnmicrbial disease
›rIVDU plymicrbial
inectin
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LABORATORY FINDINGS

›leukcytsisacute
chrnic
›elevatedESR
›H/Cpsitive  
IMAGINGPLAIN FILMS

›lssbnytrabeculatinclset
thecartilaginusplate
›irregularnarr ingthe
vertebraldiscspacebet een
invlvedadjacentvertebra
›vertebralbdycllapse
IMAGINGPLAIN FILMS

›evidentrapidbne
regeneratin bnespurs,
densene bne
±GRADE
Grader discspace
narr ing
Grade bny
destructinendplate
GradeG less bdy
destructin
Grade± mre 
bdydestructin
RADIONUCLIDE SCANS

›verysensitiveandearly
›nnspeciic
›Tc””mcmbined ithGallium
CT
›Detact beresuchchangesare
apparentnplainilms
›useulr
 detectingthepresencebnysequestra rinvlucra,
 adjacentsttissueabscesses
 indingandlcalizingtheptimalapprachrabipsy

›H ever
 earlydestructivechangesmaybemissed
 hasahighalsenegativeraterepiduralabscess
MRI
›themstsensitiveradilgic
techniquetdetectvertebral

›detectinepiduralabscesses

›butcanntbeusedinpatients
ithcertainmetalimplants
PYOGENIC VERTEBRAL
OSTEOMYELITIS

Treatment
›underlyinginectin
›H/C
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PYOGENIC VERTEBRAL
OSTEOMYELITIS
Treatment
› ATB ½ kparenteral
› cntinueralATB
› immbilized,externalbracingduring
ambulatin
› gal preservermaintainneural
unctinspntaneusvertebralbdy
usininastable anatmical
psitin
INDICATION FOR SURGERY
Spinalinstability
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Staph.aureus
Aerbicanaerbicstreptcccus
Multiplerganism[r )E.cli,Pseudmnas
aeruginsa,Diplcccus pneumniae,Serratia
marcescens Enterbacter,
TB
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SPINAL½ABSCESS
›ImagingStudies
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SPINAL TUBERCULOSIS
› Usuallyinvlvedthevertebralbdy
› invlvedneuralarch,transverse
prcess,spinusprcess
› inectinmayspreaddrsallytthe
spinalcanal
› impairedneuralunctin,cllapsed
vertebra
› cmpressthespinalcrdrcrda
equina
SPINAL TUBERCULOSIS
›Tuberculusepiduralabscessr
granulmamayalscause
neurlgicaldysunctin ithut
anyevidencebnyinvlvement
›Treatment healthe
disease,preventrimprve
neurlgicaldysunctin,prevent
anyurthergibbusdermity
 
 
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CAUSES
› ccurinislatinrinthesettinganther
illness.

› Whenitccurs ithutapparentunderlying
cause,itisreerredtasidipathic.

› Idipathictransversemyelitis isassumedtbea
resultabnrmalactivatintheimmune
systemagainstthespinalcrd.
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assciatin ithanacuteinectinranepisde
inectin).
› p  herpessimplex,herpeszster,cytmegalvirus,
EpsteinBarrvirus,enterviruses [plimyelitis,
Cxsackievirus,echvirus),humanTcell,leukemia
virus,humanimmundeiciencyvirus,inluenza,
rabies
› V  Mycplasma pneumniae,Lyme
brrelisis,syphilis,tuberculsis
› !" [rabies,c px)

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SYMPTOMS AND SIGNS
› Painintheneck,back,rheadmayccur
› eakness

› tingling

› numbnesstheeetandlegs

› diicultyvidingdevelpverhurstae 
days
› paraplegia

› lsssensatinbel thelesin

› urinaryretentin

› ecalincntinence
DIAGNOSIS
› DiagnsisrequiresMRIandCSFanalysis
› MRItypicallysh scrds ellingandhelpsexcludether
treatablecausesspinalcrddysunctin[eg,spinalcrd
cmpressin)
› Testsrtreatablecausesshuldinclude
› chestxray
› serlgictestsrmycplasma,Lymedisease,andHIV
› vitaminBr
› late levels
› ESR
› antinuclearantibdiesand
› CSF
› bldVenerealDiseaseResearchLabratry[VDRL)tests
TREATMENT
› directedatthecauserassciateddisrder

› Inidipathiccases,highdsecrticsteridsare
tengivenandsmetimesll edbyplasma
exchangebecausethecausemaybeautimmune