Spinal Infectious and Inflammatory
Lesions
- Ankylosing
Spondylitis
– 10-30 years old, 1% of population, affects site of ligament attachment
to bone
- Rheumatoid
arthritis
– 80% of cases involve the spine
- causes pannus
(can compress cord), atlantooccipital instability, necrotizing
parenchymal vasculitis, cranial settling, leptomeningeal rheumatoid
nodules
- Acute
Transverse Myelitis – acute inflammation and softening of spinal cord
throughout its cross section
- all ages,
M=F, usually thoracic spine
- MRI
normal
- Caused
by infection, vasculitis, multiple sclerosis, malignancy, lupus
- Radiation
necrosis –
usually chronic progressive
- starts
about 18 months after exposure
- painless
paresthesias (sensory > motor, white > gray)
- hyaline
intimal thickening of blood vessels causes fibrinoid necrosis and
thrombosis
- Necrotizing
Myelopathy
– Devic’s disease (form of MS), lupus, paraneoplastic
- Nonnecrotizing
Myelopathy
– radiation, AIDS (vacuolar), viral, compression, AVM, ethanol, B12 deficiency
- Infection
- Osteomyelitis – usually caused by
staphylococcus (60%) or enterococcus (30%)
- Originates
in subchondral body in adult, vascular disc space in children
- Associated
with end plate erosion and marrow changes (hypo T1, hyper T2)
- Tuberculosis – 6% of TB cases involve
spine (usually lower thoracic/upper lumbar)
- 90%
involve at least 2 bodies (50% at least 3)
- usually
associated with paraspinal abscess
- also
known as Pott’s disease
- Epidural
Abscess –
usually staph aureus; 80% have associated discitis
- This is
a true neurologic emergency since deterioration can occur suddenly and
irreversibly.
- Symptoms:
Back pain with fever (Fever and back pain represent epidural abscess
until proven otherwise)
- Higher
incidence in the immunosuppressed, IV drug abusers, diabetics, and those
with systemic infection
- Typical
organisms: S. aureus, aerobic Streptococcus, S. epidermidis, E. coli,
Enterobacter aerogenes, Pseudomonas, Haemophilis
- Diagnosis:
- Emergency
MRI of spine with T2 images (Infection generally erodes into the disc
space)
- Plain
spine films (frequently show osteomyelitis)
- CBC,
ESR, and blood cultures
- Emergent
surgery is definitive treatment