MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
155
SPONDYLODISCITIS: MODERN APPROACHES TO TREATMENT
Gafarov Jakhongir Sobirovich
https://doi.org/10.5281/zenodo.13989859
Resume; restart.
The goal of diabetes treatment is to eliminate the
pathogen, restore and maintain the structure and function of the spine, smooth
out neurological deficits, and relieve pain. Conservative therapy Conservative
treatment, which is the standard of care, is indicated in the absence of lesions
and spinal cord compression on CT and MRI. There is no disagreement on
conservative methods of therapy, and currently it includes antibacterial,
immunocorrective , detoxification therapy, physiotherapy and immobilization.
Treatment
Immobilization should be used when there is a risk of developing severe
pain and spinal instability. Antibacterial therapy Early stages of diabetes are
easy to treat with antibiotics. Immediate initiation of empiric antibiotic therapy
is recommended in patients with hemodynamic compromise, sepsis, septic
shock, or progressive or severe neurologic impairment. Antibiotics are
prescribed intravenously in maximum therapeutic doses, in some cases intra-
aortic administration of antibiotics is suggested. In other cases, the introduction
of antibiotic therapy may be delayed until the biopsy results are obtained,
because early initiation of empiric treatment leads to distortion of the biopsy
results. Empirical therapy should cover the most common pathogens of diabetes
and penetrate well into the central nervous system and bones. by opinion CE
Chenoweth [et al.] (2010), I. Moraru (2012), T. Gouliouris [et al.] (2012), K.
Zarghooni [ et al. al .] (2013), in most cases, the following combination of
antibiotics for empiric treatment is effective: 1. Preferred regimen: vancomycin
15-20 mg/kg + ceftriaxone 2 g - intravenously, every 12 hours 2. Alternative
regimen for penicillin allergy : vancomycin 15-20 mg/kg + aztreonam 2 g -
intravenously, every 8 hours. Medicines for the treatment of diabetes are
included as part of empiric therapy: cefepime 6 g - intravenously, meropenem -
daily. intravenous injection. If a pathogen is identified as a result of
bacteriological studies, rational antibiotic therapy is prescribed, which is carried
out taking into account the resistance of the isolated pathogen to antibacterial
drugs. The duration of parenteral antibiotic therapy is on average 2-4 weeks and
depends on the improvement of the clinical picture, the normalization or
significant decrease of ESR and the number of leukocytes. The level of C-reactive
protein can serve as a basis for switching from parenteral antibiotics to oral
antibiotics . If this indicator normalizes in the first two weeks of treatment, it is
recommended to switch from parenteral administration of antibiotics to oral
MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
156
administration. Treatment should continue for at least 6-8 weeks after the
symptoms of inflammation have normalized. According to many authors, the
total duration of antibacterial therapy should be from 6 weeks to 3 months in
the case of suppurative diabetes and up to 1 year in the case of tuberculosis
etiology of the disease.
Surgical treatment
The goals of surgical intervention are to destroy the infectious focus, take
a biopsy for microbiological and histological examination, decompress the spinal
canal with stabilization and restoration of damaged spinal structures. Most of
the authors (R. Sobottke [ et al .] 2008, K. Zarguni [ et al .] 2012, S. Mann [ et al al
.] 2004, RM Duarte , AR Vaccaro 2013) urgent surgery is recommended for the
development of neurological deficits, as well as spinal instability and deformity.
Absolute and relative indications for surgical treatment of diabetes are
presented in Table 1. However, the relative indications for surgical treatment of
diabetes in patients with pain and unresponsive to conservative treatment are
still controversial. Compared to conservative therapy, surgical treatment helps
relieve inflammation and pain more safely and quickly. Of course, the placement
of fixation materials in the infected area can lead to their colonization and the
continuation of the infection. If local antibiotics are used during the sanitation of
the infected bone and surrounding tissues, there may be no complications after
the installation of spinal structures. Titanium implants are recommended
because they are associated with a lower recurrence rate. The issue of optimal
surgical tactics for diabetes remains controversial. Surgical treatment of
diabetes can be done in one or two stages. If there is a neurological defect, it is
necessary to urgently decompress and stabilize the spine, because the dynamics
of the development of neurological complications depends on the speed of
surgical intervention. In patients without neurological deficits, but with co-
morbidities, a two-stage intervention is preferable. The second stage of the
operation is performed one or two weeks after the first. The type of surgical
intervention depends on the level of the lesion, the degree of destruction and the
developed complications. In this case, in the first stage of the operation,
damaged and necrotic tissues are removed by corporotransversectomy ,
discectomy or laminectomy . In the second stage, the supporting and protective
functions of the spine are restored . After the period of immobilization, the
patient is prescribed physiotherapy, ultrasound therapy, acupuncture and
exercise therapy. Long-term restriction of physical activity leads to muscle
MODELS AND METHODS IN MODERN SCIENCE
International scientific-online conference
157
atrophy. The return to normal life is carried out gradually with an increase in the
volume of load and movements;
Summary
The analysis of the literature showed that early diagnosis of diabetes remains a
difficult task, while the disease requires timely adequate treatment with
antibacterial drugs and control of their effectiveness. The approach to surgical
treatment of diabetes in pain (the nature and intensity of pain) also remains
controversial and not entirely clear, which requires further research.
Literature:
1.
Nonspecific pyogenic spondylodiscitis: clinical presentation, surgical
treatment and outcome in 24 patients / S. Mann [et al.] // Neurosurg . Attention.
- December 2004. - vol. 17, N 6. – R. E 3.
2.
2018-03-22 Treatment of adult spontaneous spondylodiscitis and its
reproduction / A. Sur [et al.] // Ann. R. Coll. Surg. English. - September 2015. -
vol. 97, N 6. – P. 451–455.
3.
Diagnosis and treatment of pyogenic osteomyelitis of the cervical spine in
adults / FL Jr. Acosta [et al.] // Neurosurg . Attention. - December 2004. - vol. 17,
N 6. – R. E 2.
4.
Bacteriological characteristics of infectious spondylodiscitis in the
Mohammed V military training hospital in Rabat / A. Zohoun [et al.] // Braz. J.
Microbiol. - October-December 2012. - vol. 43, N 4. – B. 1327–1331.
5.
Vertebral osteomyelitis, discitis and spinal epidural abscess in adults
[Electronic resource ]: guideline summary // Clearing guideline (NGC):
[Website].
-
August
2013.
–
Access:
https://www.guideline.gov/summaries/summary/47349/vertebral-
osteomyelitis-discitis-and-spinalepidural-abscess-in-adults. - Date of entry:
24.01.2018
6.
Duarte, RM Spinal cord infection: modern and management algorithm /
RM Duarte, AR Vaccaro // Eur. Spine J. - December 2013 . - vol . 22, N 12. – P.
2787–2799.
7.
Ardashev, IP Vertebral infection / IP Ardashev, EI Ardasheva // Spinal
surgery. - 2009. - No. 2. - P. 68-78.
8.
Identification of the pathogen in suspected cases of pyogenic
spondylodiscitis / AF Sheikh [et al.] // Front. Cell. Contagion. Microbiol. - March
2017. - vol. 7. - R. 60.
