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Infections (+ TB)

Aetiology

Risk factors:

  1. older debilitated patients

  2. IV drug addicts (pseudomonas)

  3. history of pneumonia, UTI, skin infection

  4. immunocompromised patient

  • 70% arise from UTI, chronically ill, elderly adults. Due to Batson's venous plexus = communication betw. pelvic & vertebral plexus.(NB surgically)

Organisms:

  • Staph aureus is most common but MRSA is on the increase

  • Gram negatives (E coli, Pseudomonas, Proteus) & anaerobes are on the increase

  • Strep viridans

  • brucellae, candidae, coccidiomycosis (in immunocompromised)

  • tuberculosis (commonest site = T10)

Site of infection:

  • lumbar spine is the area most often affected - uncommonly cause paralysis

  • thoracic & cervical regions are affected less often but have a higher incidence of paralysis

Pathophysiology

  • Haematogenous spread most common (Batson's complex)

  • Organisms settle in the in metaphyseal region of vertebral body

  • toxins cause thrombosis, infarct, abscess, blocks nutrition

  • Purulent material may break out of cortex anteriorly to form paravertebral abscess or posteriorly to form an epidural abscess.

  • weakening of the bone may cause vertebral collapse.



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