Pyogenic spondylitic osteomyelitis

　　First, etiology

　　The causative bacteria of this disease are most commonly Staphylococcus aureus. There are three routes for the bacteria to enter the spine:

　　1. Through the blood-borne route first, there are skin and mucosal suppurative infection foci, and spread through the blood-borne route.

　　2. Local spread direct invasion by soft tissue infection adjacent to the spine.

　　3. Lymphatic dissemination spreads to the vertebral bodies through lymphatic drainage.

　　Second, pathogenesis

　　This disease is more common in adults, with the lumbar spine being the most common, followed by the thoracic spine, and the cervical spine being less common. The lesions are mostly localized to the vertebral bodies, spreading to the intervertebral disc and upper and lower vertebral bodies. Occasionally, there may be spread to the vertebral arch and侵入 the spinal canal. Most cases form paravertebral abscesses, with the lumbar spine being paravertebral abscesses, and the upper cervical spine being retropharyngeal abscesses. The lesions develop rapidly, with the formation of ossified bone, fusing into bone bridges, and even intervertebral fusion may occur.

　　1. Anemia, hypoproteinemia

　　Chronic suppurative osteomyelitis has a protracted course, with long-term recurrent acute attacks, low fever, and the discharge of purulent secretions from sinus tracts, which will produce chronic consumptive damage to the whole body. Anemia and hypoproteinemia are common complications of chronic suppurative osteomyelitis. The presence of these complications further reduces the body's and local resistance to disease, adding adverse factors to the treatment of chronic suppurative osteomyelitis, thus forming a vicious cycle. Therefore, it is very important to correct anemia and treat hypoproteinemia in the treatment of chronic suppurative osteomyelitis.

　　2. Systemic amyloidosis

　　Amyloidosis is a type of tissue degeneration in pathology, divided into systemic and localized types. Systemic amyloidosis occurs concurrently with chronic suppurative osteomyelitis and similar long-term recurrent suppurative inflammation, with pathological manifestations of amyloid deposits in the intercellular spaces of systemic organs and on the basal membrane of blood vessels. The deposits are actually protein-like substances but have the property of turning blue when iodine is applied. The affected organs often suffer severe functional damage.

　　1. Acute type:This type usually originates from the blood-borne dissemination, with the patient experiencing an acute onset, aversion to cold, chills, and high fever, with body temperature reaching up to 40℃, toxicemia symptoms are evident, with significant pain in the lumbar and back or neck and back, unable to get out of bed, unable to turn over or turn the neck, with marked spasm of paravertebral muscles and the appearance of percussion pain, blood leukocyte count significantly elevated, reaching tens of thousands, with neutrophils accounting for more than 80%, and with toxic granules. Blood culture can detect the pathogenic bacteria, with high fever lasting for more than 2 weeks, with some cases developing limb paralysis. Large paravertebral abscesses can be palpated in the lumbar or gluteal region when they flow to the thigh. In such cases, early X-ray examination often shows no abnormalities, but at least 1 month later, there may be worm-eaten destruction within the vertebral bodies. Once X-ray signs appear, bone destruction develops rapidly, with the vertebral bodies becoming asymmetric and wedge-shaped, the density becoming white and hardening into ossified bone, spreading to adjacent vertebral bodies, narrowing the intervertebral spaces, and showing paravertebral abscesses. Finally, bone bridges or bony fusion between vertebral bodies may form, and CT and MRI can detect the destruction foci within the vertebral bodies and paravertebral abscesses in advance.

　　2. Subacute type:These cases usually have a history of abdominal inflammation or postoperative infection after abdominal surgery in recent days, and develop back and waist pain and fever soon after the infection focus is controlled or after discharge from the hospital after surgery for suppurative appendicitis. The body temperature is generally not higher than 39°C, and the symptoms of sepsis are also relatively mild. There is an increase in the white blood cell count and an acceleration in the erythrocyte sedimentation rate. The pathological changes of this disease occur at the edge of the vertebral body, so early X-ray examination often shows no positive findings. The X-ray manifestations often delay for 1 to 2 months and appear as destruction of the vertebral body edge, narrowing of the vertebral space, and progressive bone sclerosis. The pathogenic bacteria in most of these cases are relatively non-toxic, or the body's resistance to the patient is relatively strong, so the whole course is characterized as a benign process.

　　3. Chronic type:The onset is insidious, and patients may experience back and waist pain without realizing it, without radicular symptoms, with a normal body temperature or only low fever, resembling tuberculosis. The white blood cell count is not high, but the erythrocyte sedimentation rate may increase. Early X-ray examination often shows no positive findings. One to two months later, the vertebral body shows diagonal lines, with half of the vertebral body density increased, showing signs of bone sclerosis. As the lesion progresses, the vertebral space becomes progressively narrower, usually taking half a year. If the patient is older, they are often diagnosed with metastatic sclerotic bone tumors. After taking antibiotics, the symptoms will improve, but they will recur, so the whole course is characterized by a chronic and protracted course.

　　1. Pay attention to diet

　　1. In the early stage of treatment for osteomyelitis, emphasize and advocate for light and delicious vegetarian diets. Since vegetarian diets can provide the most natural, easiest to digest, and most easily absorbed nutrients. If vegetarian diets are properly prepared, the three major nutrients needed by the human body, such as sugar, fat, and protein, are very rich and sufficient to meet the reasonable needs of the human body. The repair of bone and soft tissues also cannot do without vitamins, trace elements, and macrominerals, as well as protective plant hormones and fiber substances. The alkaline substances contained in vegetarian diets are the most abundant, such as calcium and potassium ions, which are the most active in the body, and their content in fruits is very high.

　　2. Avoid eating a large amount of meat and eat less vegetables and fruits.

　　Nursing for diseases

　　General care: Inquire in detail about the medical history, understand the cause and course of onset, and record in detail. Advise bed rest, limit activities, drink plenty of water, avoid wind and cold, and prevent external infections. Measure body temperature and pulse regularly, and provide physical or drug-induced hypothermia and maintain electrolyte balance in case of high body temperature.

　　At the time of diagnosis, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. The radioactive isotope imaging of this disease: MRI examination is helpful for early diagnosis, and X-ray examination shows no bone changes in the early stage, but can be compared with the changes of X-rays after one week.

　　In the early stages of treatment, emphasis is placed on and advocated for light and delicious vegetarian food for patients with osteomyelitis. Since vegetarianism can provide the most natural, easiest to digest, and most directly absorbable nutrients. The patient's diet should be light and easy to digest, with more fruits and vegetables, a reasonable dietary combination, and attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　I. Treatment

　　1. Early and sufficient broad-spectrum antibiotics Early use of sufficient and effective antibiotics. Blood culture can help identify the pathogen and select appropriate antibiotics. Oral antibiotics should be used for at least 4-6 weeks after the control of systemic and local symptoms.

　　2. General Therapy General supportive therapy is very important.

　　3. Immobilization Acute cases are mostly caused by highly pathogenic hemolytic Staphylococcus aureus, with a strong tendency for intervertebral bony fusion. Once complete fusion occurs, there are rarely any residual symptoms. Subacute and chronic types have lower virulence of pathogenic bacteria, mainly Staphylococcus albus or other bacteria, which are not easy to produce bony fusion and are prone to produce lumbar instability and recurrent acute attacks. Therefore, it is advocated to sleep in a plaster bed or wear a plaster lumbar corset with one thigh after the onset or diagnosis to facilitate the connection of the bone bridge.

　　4. Choose surgical therapy for purulent vertebral osteomyelitis primarily with medication. Only those with paraplegia or massive paravertebral abscesses require surgical treatment. The need for decompressive laminectomy, debridement of the focus, or abscess drainage is determined based on the patient's condition and general health.

　　II. Prognosis

　　Early diagnosis and early treatment. Select effective and sufficient antibiotics and supportive therapy, and choose surgical treatment when necessary. Generally, the prognosis is good.