1. Spinal Infections Treatment (3)
Indications for surgical Rx
Unable to obtain diagnosis by closed means
Significant abscess formation
Failed medical Rx (antibiotics / immobilisation) including intolerance
Bone destruction with deformity / instability
Progressive neurological deficit

2. Spinal Infections Treatment (4)
Principles of surgical Rx
excise necrotic tissue back to healthy margins
decompress spinal canal where necessary
tissue samples for microbiology / histology
reconstruction / stabilisation of defect
approach and technique dictated by spinal level and region to be debrided

3. Spinal Infections Outcome (1)
Successful non-op Rx predicted by
age < 60 years
immune competence
S aureus infection
 ESR (or other inflammatory index)
(in absence of indication for surgical Rx)

4. Spinal Infections Outcome (2)
Surgical Rx outcome
less chronic back pain overall (cf non-op)
related to pre-op neurological status
(quad < paraplegic < paraparesis)
epidural abscess < granulation tissue

5. TB Spine

6. Predisposing factors
HIV and Acquired Immuno-deficiency Syndrome
Socially deprived
Ageing population
Intra-venous drug abuse
Previous infections or malignancy

7. Clinical Presentation
Constitutional
Local
Deformity
-Knuckle (collapse of one vertebra)
-Gibbus deformity (more than one vertebra)
Cold abscess (retropharyngeal/chest/psoas abscess)
Paraplegia
-Early onset
Late-onset

8. Investigations WBC ESR CRP Chest x-ray Mantoux or Heaf skin test
Enzyme-linked immunosorbent assay (ELISA)
Polymerase chain reaction (PCR)
Plain radiographs
CT scan
MRI scan
CT guided biopsy (histological or microbiological confirmation)

9. D/D
1-Brucellosis
2-Malignancy
3-Pyogenic osteomyelitis,

10. Management Medical treatment
Rest/Plaster jacket/Multi-drug anti-tuberculous chemotherapy

11. Surgical Treatment
Decompression, correction of deformity & anterior spinal fusion

12. Thoracic TB - MRI

13. Thoracic Tuberculosis - Postoperative Appearances