Infectious Causes Of Cervical Spine Pain

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[edit] Infectious Causes Of Cervical Spine Pain

This includes two infectious processes, osteomyelitis and discitis. With discitis the infection is often in children aged 4 to 10 and there is little systemic evidence of an infection. These children complain of a stiff spine, which they do not want to bend.

Blood tests show often a normal white blood cell count, but an increase in the sedimentation rate (ESR). X-rays show a narrowed disc space, which in childhood is unheard of. A technetium bone scan shows uptake at the affected disc space. An MRI scan shows changes of discitis earlier than the bone scan, as it is more sensitive. The causative organism os mostly Staphylococcus aureus , a common pus producing bug. Occasionally tuberculosis can be isolated. Treatment is with antibiotics intravenously first and then orally for a prolonged period of time.

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[edit] Osteomyelitis of the neck

Osteomyelitis of the cervical spine may intially start quite slowly, but eventually gains momentum and leads to a generally sick patient. Fever, spinal pain and often neurological deficits from irritation of nerve roots are common. Particularly in elderly patients who seem to be more at risk of getting this illness there are often concomitant other illnesses such as diabetes mellitus, rheumatoid arthritis, steroid therapy for illnesses and other staphylococcus infections.

In this patient group the immune system is weakened and this predisposes them to getting osteomyelitis. Gun shot wounds put a person at a high risk for getting osteomyelitis and a thorough work-up is indicated. Patients with pneumonia or urinary tract infections and IV drug users have a higher chance of getting osteomyelitis of the spine. Gallium bone scan testing will localize the infection. As there is a higher risk for serious permanent neurological damage, an open biopsy with bone sample removal for culturing is often necessary.

Staphylococcus aureus infection is common. In drug addict more rare conditions such as brucellosis, tuberculosis, candidiasis and coccidiomycosis are fairly common. Treatment is given and modified according to the culture reports and the clinical response.

The bone structure of the vertebral bodies of the cervical spine can be changed due to general metabolic changes that lead to osteoporosis or osteomalacia.

For instance with rickets in childhood or with osteomalacia in adults the underlying common denominator is a vitamin D deficiency. This leads in turn to a lack of calcium absorption in the intestinal canal. Without calcium there is insufficient bone formation and mineralization. Osteoporosis results when in postmenopausal women there is a lack of estrogens. But men with andropause also can get osteoporosis and int them it is because of a lack of testosterone.

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References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 2.

2. D Irnich et al. BMJ 2001 Jun 30;322(7302):1574.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 140.

4. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

5. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

6. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier