Lecture: Spinal Infections: Differential Diagnostics, Treatment Decisions, Principles

DOI 10.28962/01.3.147

In this spine surgery lecture, the principles of the diagnosis and treatment of pyogenic spinal infections are presented. Without a secured diagnosis, the decision for or against surgery as well as for the timing of surgery may rest on soft ground. All types of surgical approaches may be needed. Sterile cultures may point towards tuberculosis, but there are other infections that are hard to identify – suspicion is key. Quality biopsies are very valuable in our experience, even though some literature concludes to the contrary. When screening for infection (especially multifocal), PET-CT followed by MRI are most sensitive. Patients with SEA mostly benefit from rapid surgical decompression. When deciding on whether an “epidural abscess” is indeed drainable, MRI without contrast-enhanced T1-sequences may be misleading. There are currently updated, evidence-based guidelines for the institution of empiric antibiotic therapy in the presence of spondylitis / spondylodiscitis. When using implants, FU imaging / resistance to infection should be considered. It is no longer simply “titanium is best”. There are considerable developments in the implants arena – with regards to implant materials as well as with regards to infection-preventing coatings of standard metallic implants.