Spondylitis is an inflammatory disease of the spine. Such inflammation can occur after any common infectious disease.
Spondylitis is primary and secondary in origin. The clinical picture of spondylitis can be acute and chronic. At the same time, there are significant differences in the clinical picture of spondylitis due to the localization of the inflammatory process in the spine and the prevalence of bone destruction.
Types of spondylitis
The most frequent infectious disease of the spine (spondylitis), occurring in most cases chronically, was tuberculosis, the rarest and most severe - acute osteomyelitis. Those changes that develop in tuberculous spondylitis over weeks, months, and years are played out in acute osteomyelitis of the spine in just a few days. Between these two extreme forms of inflammatory diseases of the spine lies spondylitis after such infectious diseases as typhoid, syphilis, gonorrhea, actinomycosis, brucellosis, etc.
The mobility of the spine in spondylitis of any etiology is sharply impaired by the reflex tension of the paravertebral muscles, which block the movement of the spine in all directions (concentric limitation of mobility). No other spinal disease has such a widespread and pronounced reflex-pain limitation of movements as spondylitis.
Acute osteomyelitis of the spine
Acute osteomyelitis of the spine is a serious disease that is difficult to recognize, especially since patients often die a few days after the onset of the disease from "cryptogenic" sepsis. At least half of all recognized diseases of acute osteomyelitis of the spine affect young people. Most often, the focus of acute osteomyelitis is located in the lumbar spine, rarely in the cervical.
In acute osteomyelitis of the spine, damage to the vertebral bodies, and sometimes the arches, can occur as metastasis in furunculosis, angina, dental caries, after removal of the prostate gland or kidney, after operations on the bladder or intestines.
Local infection was observed during the lumbar therapeutic injections of the sympathetic borderline trunk, lumbar puncture, anesthesia, and operations on intervertebral discs.
Syphilitic spondylitis usually occurs in the form of gummy periostitis or osteomyelitis and rarely specific periostitis. Syphilitic spondylitis can be congenital (very rare) and acquired. With syphilitic spondylitis, the cervical vertebrae are mainly affected.
The disintegration of gum in the vertebral body can cause pathological compression of the spinal cord and its roots. The limitation of mobility of the spine in syphilitic spondylitis, found on examination, is very similar to tuberculous spondylitis.
Typhoid spondylitis is a consequence of typhoid septicemia. Foci of typhoid infection sometimes remain dumb and are cured without clinical manifestations. Typhoid spondylitis usually affects two adjacent vertebrae with an intervertebral disc located between them.
In typhoid spondylitis, most often the lesion is localized in the lumbar spine, especially in the lumbar-thoracic and lumbosacral regions. The destruction of the intervertebral disc and synostosis of the vertebrae in typhoid spondylitis occurs quickly with or without the formation of an abscess.
The mobility of the spine with typhoid spondylitis is limited in the lumbar and thoracic regions. Fixed lordosis in typhoid spondylitis is caused by reflex hypertonicity of the back extensor muscles.
Brucellotic spondylitis usually occurs in people who have contact with cattle (shepherds, veterinarians). Infection with brucellosis spondylitis can occur with the ingestion of raw milk from infected cows.
Symptoms of brucellosis spondylitis appear 8-12 weeks after the onset of the disease. Brucellotic spondylitis occurs with wave-like fever, chills, weakness, headache, etc.
Brucellotic spondylitis affects the vertebral bodies, paravertebral soft tissues, sacroiliac joints, small joints, and discs over a large area of the spine. Due to severe pain in brucellosis spondylitis, which with difficulty subsides under the influence of rest and drug treatment, the spine becomes rigid almost along its entire length.
The inflammatory diseases of the spine also include allergic spondyloarthritis (progressive chronic spondylitis, ankylosing spondylitis, rheumatoid spondyloarthritis).
Spondylitis treatment depends on its type. In case of detection of osteomyelitis of the vertebral body, they resort to surgical treatment. Surgical treatment of vertebral osteomyelitis is the task of removing infected bone masses with the emptying of all purulent cavities and leaks.
In the case of tuberculous spondylitis, the treatment tactics are conservative. Course doses of specific anti-tuberculosis drugs are used with accompanying physiotherapy, therapeutic massage, and wearing corsets.
In some cases, the resulting bone defects of the vertebrae may require their remodeling (vertebroplasty) or compensation with bone cement, implants, and systems that stabilize the spine.
All operations for vertebroplasty and stabilization of the vertebrae are performed exclusively after the sanitation of all foci of vertebral spondylitis.