General principles in the medical and surgical management of spinal infections: a multidisciplinary approach.
OBJECTIVE
Infections along the spinal axis are characterized by an insidious onset, and the resulting delays in diagnosis are associated with serious neurological consequences and even death. Infections of the spine can affect the vertebral bodies, intervertebral discs, spinal canal, and surrounding soft tissues. Neurological dysfunction occurs when the spinal cord becomes compressed, edematous, or ischemic due to compression by abscess or vascular compromise. The aim of this paper was to detail general diagnostic and management principles for this disease.


METHODS
Recent progress in medical technologies, including the development of potent antimicrobial drugs, advanced imaging, and improved surgical methods, have dramatically reduced morbidity and mortality rates for spinal infections; however, debate still exists on the proper management of this disease. In this paper, the authors review the current management protocols for spinal infections at their institution, focusing on medical and surgical treatments for vertebral osteomyelitis, intervertebral disc space infections, and spinal canal and soft-tissue abscesses.


CONCLUSIONS
Technological advances in imaging modalities, pharmaceutics, and surgery have resulted in excellent outcomes and have greatly reduced the morbidity and mortality rates associated with spinal infections. Currently, treatment of spinal infections requires a multidisciplinary team that includes infectious diseases experts, neuroradiologists, and spine surgeons. The key to successful management of spinal infections is early detection.
Quiñones-Hinojosa
Alfredo
A
Department of Neurosurgery, University of California, San Francisco, California 94143-0112, USA. quinines@post.harvard.edu
Jun
Peter
P
Jacobs
Richard
R
Rosenberg
William S
WS
Weinstein
Philip R
PR
D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D019468:Disease Management; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods