OKOJ, Volume 14, No. 9

Spine infection is a serious illness that can lead to considerable disability and even death. A prompt diagnosis and proper treatment are critical to eradicate infection. Neurologic sequelae such as cauda equina syndrome, paralysis, or cognitive dysfunction due to meningitis can result, adding a sense of urgency to the diagnosis and treatment. Spinal deformity also can result, even if the infection has been eradicated. Regardless of the specific characteristics of the infection, successful treatment involves an accurate diagnosis and species determination, appropriate antimicrobial treatment, and surgery in some circumstances. The treatment goals are pain relief, infection eradication, the maintenance or restoration of spinal alignment and stability, and the preservation of neurologic function. An understanding of general patient demographics and diagnosis and treatment considerations for vertebral discitis and osteomyelitis in the adult and pediatric populations, epidural abscesses, and postoperative surgical site infections is important. Recent developments include new diagnostic tools, the evolving role of negative pressure wound dressings, a better understanding of the risk factors for surgical site infection, related strategies to reduce postoperative infections, and emerging minimally invasive surgical techniques.

Cervical spine injuries are common, occurring in approximately 2.4% of all blunt trauma patients. It is critical that cervical spine precautions are maintained in all of these patients. The accurate and prompt diagnosis of a cervical spine injury is paramount, because an unrecognized injury may lead to permanent neurologic sequelae. At the hospital, CT has been shown to be the most accurate and cost-effective screening modality. Early decompression has been associated with significantly improved long-term neurologic outcomes.

Patients with multiple injuries push physiologic limits, demanding expert and efficient evaluation and treatment to limit morbidity and mortality. The mortality risk of polytrauma patients is predicted best by a combination of trauma scores and physiologic markers. Recent advances in the initial management of such patients include a more balanced resuscitation with whole blood and a role for tranexamic acid as an antifibrinolytic agent. Appropriate initial management may include pelvic binding and packing for hemorrhage from unstable pelvic fractures, and tourniquet use for uncontrolled exsanguination from the extremities. If the treating facility cannot meet the needs of the injured patient, timely and safe transfer to a trauma center is critical. Preventing the complications of open fractures and compartment syndrome requires emergent surgery. Early fixation of long bone and unstable pelvic fractures also is associated with improved outcomes. These interventions must be completed while respecting the appropriate endpoints of resuscitation, such as lactate levels and base deficit, to limit exacerbation of the systemic inflammatory response to trauma.