Abstract
Purpose
To report a retrospective study of 103 cases of primary spinal infection, the largest ever such series from the UK, analysing presenting symptoms, investigations, bacteriology and the results of treatment.
Method
This is a retrospective review of all patients (54 Male, 49 Female) treated for primary spinal infection in a Teaching Hospital in the UK.
Results
Patients predominantly presented with back pain (78%). Mean time from onset of symptoms to presentation was 72 days. The majority of cases involved patients over 50; however a significant peak also occurred amongst patients in their 20s and 30s. Common co-morbidities in the older age group included diabetes mellitus, renal failure and malignancy whereas the prevailing co-morbidity in the younger group was intra-venous drug abuse.
White cell count was infrequently elevated in cases of spondylodiscitis but more commonly so with epidural abscess. The CRP was elevated in most cases at presentation and fell by an average of 62% by the time of discharge.
Biopsies were performed in 60% of cases with open biopsy significantly more likely to yield a positive culture than percutaneous techniques. Epidural abscess was the most common diagnosis (42%) with spondylodiscitis, isolated vertebral osteomyelitis and discitis occurring less frequently.
The most commonly isolated organism was staphylococcus aureus (51%). Of these, ten cases were infected with Methicillin Resistant Staphylococcus Aureus (MRSA). No organism was isolated in 37% of cases. 28 % of patients were treated with antibiotics alone; the remainder also underwent surgery, most frequently by a posterior approach. Fusion was achieved in 42%. 86% of patients improved symptomatically and 89% cases of paraparesis recovered to some degree after surgical decompression.
Conclusion
Our overall impression is of the emergence of a young group of patients with primary spinal infections relating to Intravenous Drug Abuse and of increasing incidence of MRSA as a causative organism.
