Osteomyelitis of the spine: classification, symptoms and diagnosis

Osteomyelitis: causes of development, symptoms and diagnosis

Osteomyelitis is a rare disease, which, in fact, is a suppurative process. This pathology develops in the bones and bone marrow, causing extremely negative consequences for health.


What is osteomyelitis?

This term is understood the inflammatory process in the bone marrow in which there is a failure of all elements of bone – compact and spongy substance of the periosteum. According to statistics, osteomyelitis after surgery and traumatic injuries is 6.5 % of all disorders of the musculoskeletal system.

Typically, this process involves the Shin bone, upper jaw, vertebrae, humerus and femur, and mandibular joints. It is worth noting that men osteomyelitis is more common than in women. In addition, children and the elderly are affected by this pathology more than the young.

Classification of osteomyelitis

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Osteomyelitis can be divided into two types:

  1. Sharp. This form of disease is diagnosed, when she appeared for the first time. It is characterized by sudden inflammation. In this case, it is impossible to do without antibiotics, or may begin complications – for example, to develop an abscess.
  2. Chronic. This form of the disease is diagnosed in case of a prolonged course with periods of exacerbations and remissions. I must say that this osteomyelitis is a serious threat to human health because it is accompanied by a constant process of destruction. Chronic disorders, in addition to bone tissue, affecting bone marrow, which can cause blood diseases.

Depending on the way of penetration of bacteria there are two types of acute osteomyelitis endogenous and exogenous.

1. Endogenous osteomyelitis

It is also called hematogenous. Developing this form of the disease in that case, if the causative agent was entered through the blood. Usually this kind of disorders observed in children. There are such types of endogenous osteomyelitis:

  • septico-piemina;
  • local;
  • dinamicheskaja.

2. Exogenous osteomyelitis

Is usually the result of traumatic injuries. There are such types of exogenous osteomyelitis:

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  • PTSD develops as a result of open fracture;
  • firearms – appears in the case of extensive lesions of the bones and soft tissues;
  • postoperative – develops for non-compliance antisepsis when performing orthopedic operations;
  • contact – appears in the result of purulent processes in soft tissues surrounding the bone.

The reasons for the development of different types of the disease

The main reason for the development of osteomyelitis involves the introduction of bacteria into the bone tissue. Infection can occur endogenous or exogenous. In the first case pathogens get into the bone through the blood. In the second case, they penetrate from the environment.

Osteomyelitis can lead to destruction of the bone marrow and tissues. It is therefore important at the onset of signs of disease immediately consult a doctor.

Activators of endogenous osteomyelitis are streptococci and staphylococci. When exogenous form of the disease often identify multiple organisms, but is most common Pseudomonas aeruginosa.

Causes of acute hematogenous osteomyelitis are various infections:

  • tonsillitis;
  • abscess teeth;
  • boils;
  • inflammation of the middle ear;
  • omphalitis;
  • panaritium;
  • pyoderma.

Also endogenous osteomyelitis may act as complications of infectious diseases – measles, scarlet fever, pneumonia.

Causes of post-traumatic osteomyelitis can be:

  • extensive contaminated soft tissue injuries;
  • gunshot wounds;
  • surgical treatment of a closed fracture with the use of metal wires, plates, screws;
  • open fractures.

Contact osteomyelitis occurs because of an infection in the bone from the surrounding soft tissues. This occurs if there is a purulent lesion – abscess or cellulitis.

Additional factors provoking the development of this pathology are:

  1. Atherosclerosis.
  2. Excessive consumption of alcohol, taking intravenous drugs, Smoking.
  3. Diabetes.
  4. Varicose disease.
  5. Frequent infections, which may indicate failure of the immune system.
  6. Malignancy.
  7. Disorders in the functioning of the liver and kidneys.
  8. Old age.
  9. Removal of the spleen.
  10. Low body weight, poor nutrition.

Symptoms of pathology

All types of osteomyelitis are accompanied by the following symptoms:

  1. General weakness and malaise.
  2. Pain in the muscles.
  3. The increase in body temperature. The higher the number, the stronger the human immune system fights infection.
  4. The occurrence of symptoms in 3-4 days after infection of bone.
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Local reaction appear quickly enough. Literally two days after infection causes marked localized pain. The limb takes a forced situation. The patient is unable to make active movements whereas passive is severely restricted.

In a short time can increase soft tissue swelling. The skin in the area of the lesion is hyperemic and tense. Can be pronounced venous pattern. In addition, it often increases local temperature. There is often development of arthritis of adjacent joints – initially serous and later purulent.

Diagnosis of various types of diseases

To diagnose osteomyelitis conducted a number of studies. First, perform a General blood test which will show elevated levels of neutrophils and leukocytes.

The number of red blood cells will be reduced, as they are produced in red bone marrow, which is diseased.

The erythrocyte sedimentation rate in this pathology increases.

  • Microbiological study. The determination of the diagnosis depends on the isolation of pathogenic microorganisms from the damaged bones, joint fluid and blood. To determine the origin of that disease, it is best to apply the materials of the biopsy – they reveal the true pathogen in 75% of cases. Can also be used bacterioscopy serological methods for determining the causative agent, gas-liquid chromatography, the anaerobic technique of research.
  • X-ray examination. The following diagnostic procedure is an x-ray. It is through this study can detect changes in bone structure. Osteomyelitis is thickened at the extreme edge of the bone, while the epiphysis, in contrast, is flattened. In the case of hardening the radiograph shows reduction of the diameter of the lumen of the canal of the bone.
  • CT. This kind of research is considered more accurate than x-rays. It gives the opportunity to detect changes in bone tissue and to identify pockets of pus. Also with the help of tomography cannot determine the degree of damage, because osteomyelitis may have single or multiple foci.
  • Fistulografiya. This method of research is known as the most reliable. During the procedure, the bone injection of contrast medium and the image displayed on the monitor. With the help of this study cannot determine the nature of the disease and the degree of damage bone.
  • Magnetic resonance imaging. This procedure has a high sensitivity and allows you to accurately determine bone pathology. Through this study it is possible to distinguish infection of the soft tissues adjacent to bone, from the true inflammatory changes in the bone canal.
  • Ultrasound. This is a fairly robust and informative method of revealing of places of a congestion of pus. It allows to detect soft tissue swelling, the defects on the surface of bone, accumulation of fluid in the joint, peristeriou reaction, cortical and bone sequesters.
  • Radionuclide diagnostics. This procedure is used for early detection of the disease, location and extent of development process. Most commonly used bone scintigraphy with 11Тс. An accurate diagnosis is possible already in the first days after onset of illness. If the diagnosis is in doubt or the need to assess the degree of inflammation is applied radionuclide scan with 99mTc.
  • Immunoscintigraphy with the use of white blood cells. Its principle is based on the migration of leukocytes in the affected area. This technique is considered the most accurate and can be used for the diagnosis of osteomyelitis.
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Osteomyelitis is a terrible disease, which without adequate treatment can cause dangerous complications. Therefore, it is important to know what the symptoms of osteomyelitis of the spine is typical and when to see a doctor.

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