Spinal Infections

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Discitis and vertebral osteomyelitis develop more frequently in young children than in adults, probably because the increased vascularity of the intervertebral discs and cartilaginous vertebral endplates of young children make them more susceptible to hematogeously spread infections. The L2-3 and L3-4 levels are the most frequently affected disc spaces. Affected patients present with fevers and back pain, or with a complaint of refusal to walk. MRI is the preferred imaging modality, and demonstrates T2 hyperintensity and enhancement of the infected disc. Similar changes are evident in the adjacent vertebral endplates, epidural space and paraspinous soft tissues if they are also involved. In the late stages of infection, erosion and collapse of the infected vertebral body can occur, resulting in significant spinal deformity. Other modalities such as plain films, CT or radioisotope studies are either less sensitive or less specific than MRI.

Spinal epidural abscesses are neurosurgical emergencies because they can enlarge rapidly and cause cord compression and infarction, with resultant paraplegia. The main mechanisms of infection are hematogenous seeding of or direct extension of adjacent discitis/osteomyelitis into the epidural space. Patients initially present with fevers, back pain and focal spinal tenderness. Without treatment, sphincter dysfunction, and sensory changes and weakness in the lower extremities can develop. MRI is the study of choice and will typically show a fluid collection or mass in the epidural space that is T1 hyperintense and T2 hypointense compared to CSF. Enhancement usually occurs along the margins of the collection but can be homogenous in the case of epidural phlegmons that have not yet liquefied.

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