In the case of a high-grade infection with the signs of bacterial seeding (high fever, chills) of spondylodiscitis, surgical treatment of the focus of the infection must usually be carried out immediately. The decision is made by the doctor in each individual case. It is difficult to generalize on the procedure.
The possible surgical measures in the case of spondylodiscitis include Already before, but at the latest after the operation, a therapy with a bacteria-killing medication (antibiotic) is started.
- Complete removal of the pus (irrigation, removal of dead tissue, etc. )
- Placement of antibiotic carriers in the cleaned infection center
- If necessary, spraying the vertebral body with antibiotic cement
- If necessary, disc replacement surgery (cages, see spondylodesis)
- If necessary, vertebral body stabilization and relief through bridging stiffening of the spinal column section
- If necessary, vertebral body replacement surgery
If the course of the disease is less acute and early diagnosis is made, conservative therapy of spondylodiscitis may be sufficient.
The decisive factor in therapy here is the sufficiently long administration of an antibiotic sensitive to the type of bacteria. In order to determine the type of bacteria, it is necessary to puncture the focus of the infection. This can be done in a controlled manner using an imaging procedure such as computer tomography or a mobile X-ray unit (X-ray image converter).
The sample obtained is sent for bacteriological examination. Unfortunately, the detection of germs is not always possible. Even before the results of the bacteriological examination are available, a broad range of antibiotics must be administered.
Broad-spectrum antibiotics are suitable for this purpose, as they have a particularly large germ spectrum, i.e. they are capable of killing many of the common types of bacteria. In most cases, several different antibiotics must be given at the same time to prevent the infection from spreading as safely as possible. Antibiotic therapy for spondylodiscitis is administered at the beginning of the therapy via the vein (intravenous) as a drip (infusion), because this is expected to increase the effectiveness of the drug.
Some antibiotics can also only be administered intravenously because they are not absorbed via the gastrointestinal tract or would be destroyed. If the infection is “under control”, i.e. the inflammation levels are continuously decreasing, the therapy can be switched to an oral antibiotic. Overall, antibiotic therapy often lasts for months.
Regular checks of the inflammation parameters are necessary. Because antibiotics can also cause damage to the kidneys or liver, the “kidney and liver values” must also be regularly determined in the blood. Another principle in the therapy of inflammation is the immobilization (retention) of the affected region.
In the case of spondylodicitis, this can be done with a plaster corset or a factory-made bodice, depending on the severity of the inflammation. In addition, there is at least temporary bed rest or limited bed rest (the patient may go to the toilet).