Abstract
Introduction
With increased risk and predisposing factors, the incidence of pyogenic spondylitis is rising. The term locus minoris resistentiae is defined as a place of less resistance, any part or organ which is more susceptible than others to the attack of a morbific agent. Hence the posttraumatic spondylodiscitis becomes not uncommon with acute or chronic presentation. In the literature only 17 publications (1939–2012) are reporting on a total of 20 cases.
Material and Methods
A retrospective uncontrolled clinical case-series in a single institution. Between January 2000 and May 2015, 17 patients were operated due to vertebral osteomyelitis after spinal fracture. We have analyzed the preoperative condition, risk factors, diagnostic findings, time between fracture and presentation, causative organism, treatment and outcome
Results
Total of 17 patients; 9 males and 8 females with mean age 68 years (44–81). High energy Trauma was reported by 5 patients. The mean interval between the fracture and spinal infection was 111.6 days (5 - 601). Twelve patients presented within less than 3 months of the fracture, whereas 5 presented later. Affected region was lumbar in 12, thoracic in 4 and cervical in one patient. Comorbidities were found in 94% of the patients: DM in 9 cases, renal insufficiency in 6 and cardiac diseases in 8 cases. Associated infections had been detected in 12 (71%). Mean CRP at time of presentation was 115 mg/l, WBCs 11x103/mm3 and ESR 81 mm/hr. The most common isolated organism was Staph. aureus in 9 cases (53%). Mean VAS after injury was 6.8/10 and at the time of presentation with spinal infection was 7.8/10. The most common presenting symptoms were increased local pain in all patients, fever in 11 and neurological manifestations in 6 patients. All patients except 2 patients, who died preoperatively, had been treated surgically (anterior Debridement and posterior stabilization).
Conclusion
Spinal osteomyelitis is commonly caused by hematogenous seeding. Predisposing factors that compromise the immune system render the host more susceptible to spinal infection. The fracture hematoma represents a suitable site for inoculation and development of infection and this can explain the acute presentation. The altered local vascularity at the fracture site can lead to blood stagnation and facilitate the bacterial seeding. Inflammatory parameters can be mildly elevated after trauma and should be differentiated from increase due to infection.