Abstract
Introduction: Spinal infections are uncommon, but if the diagnosis is delayed or missed, serious consequences may occur. Recently, there have been major advances in diagnosis and treatment of spinal infections.
Aim: To document the evolving clinical picture, diagnosis and treatment of spinal infection over 20 years.
Methods: Prospective and retrospective data were collected by the infectious diseases services of a metropolitan referral centre and a provincial region. The clinical features, investigations, treatment and outcomes were analysed and comparisons were made between two periods; 1980–1992 and 1993–1999, and between the separate centres.
Results: One hundred and fifteen patients presented, with an estimated incidence of 1.7 cases/100,000/yr. The median age increased from 55 to 63.5 years and median time to diagnosis decreased from 28 to 21 days. The most common symptom was local back pain [112/115 (97%)] and the most common sign was local tenderness [88/115 (77%)]. A fever was present in 73/115 [63%]. Forty-one patients had neurological signs [36%] and 50 [43%] had epidural masses. MRI scanning was the most accurate imaging method. All patients received antimicrobial therapy, 27 [23%] partly through an at-home programme. Forty-nine patients [43%] required surgery. At follow-up, 76% were considered cured without neurological deficits. The outcomes improved over time and the differences between services reflected referral patterns.
Conclusions: Over the last 20 years the management of spinal infection has evolved through new diagnostic technology, prolonged treatment with antimicrobials, appropriate surgical intervention and a multidisciplinary approach. Heightened awareness of the condition is required to minimise the potentially serious consequences.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
