Osteomyelitis is a medical condition that results from bone infection. The bacteria Staphylococcus aureus is usually the cause of Osteomyelitis. Other possible causes for Osteomyelitis are streptococcus and E. coli. Infection is caused either through the bloodstream or direct bone infection through open wounds or fractures. Surgery, fungal infection, injury or boils can be the source for contamination and infection. Typically the infection results in the formation of pus and abscess in the bone. The blood supply to the bone is affected and Osteomyelitis sets in. Osteomyelitis can affect adults and children. While the long bones of the limbs are usually affected in children, the pelvic or back bone of adults is affected. Chronic Osteomyelitis sets in when there is prolonged loss of blood supply to the affected bone tissue. This can happen in diabetics, dialysis patients and those who abuse drugs intravenously. Persons whose spleen has been removed may be at higher risk for Osteomyelitis.
Osteomyelitis can attack more than one bone at a time. Symptoms of Osteomyelitis are localized swelling and redness in the affected bone area. The patient feels ill and nauseous. There might be fever and pain too. In some cases, Osteomyelitis also results in swelling of feet and ankles or lower back pain. The nagging joint pain fails to respond to pain medications and there is intense pain on touching. There is weight loss and severe fatigue. Tests to diagnose this condition include bone scans and MRI of infected bones. Blood tests and cultures can help identify the type of bacterial infection so that the right course of treatment can be adopted. Blood tests will reveal higher ESR and elevated WBC count in those affected by Osteomyelitis. X-rays can reveal the extent of infection in the affected bone. A biopsy of affected bone tissue can also help identify the bacterial infection.
With early diagnosis, this infection can be treated with antibiotics. Often the antibiotics are given intravenously. Treatment for Osteomyelitis involved hospitalization and bed rest. But newer forms of oral antibiotic therapy have been successful in penetrating bone tissue. This has drastically reduced the need for prolonged hospitalization. In chronic cases of Osteomyelitis, surgical removal of dead bone tissue is required. Bone grafting is done to promote growth of new bone tissue. In rare cases, Osteomyelitis can lead to blood poisoning (septicemia) and destruction of the bone.
Vertebral Compression Fracture
Vertebral compression fracture occurs when a part in the vertebra collapses due to the compression of the bone in the spine. With age, vertebrae is weakened and loses its strength and leads to a condition called osteoporosis. Osteoporosis is a kind of bone loss that causes bones to break easily. Osteoporosis is the leading cause of vertebral compression fractures especially in the age group of 40 to 50 and above. Post menopausal women and men above the age of 65 years are at highest risk of suffering from vertebral compression fractures.
Apart from osteoporosis, there could be other reasons that lead to vertebral compression fractures. Young adults suffer from vertebral fractures due to spinal injuries during rigorous exercises, sports activities or accidents. These compression fractures normally heal within 8 to 10 weeks with good rest and pain medication. Vertebral compression fractures may also be attributed to cancer tumors associated with multiple myeloma and metastatic bone disease. In very rare cases, infection or Osteomyelitis of the vertebra also results in compression fractures.
Wedge fractures are the most common type of compression fractures wherein the front part of the vertebral body collapses and becomes wedge shaped. Other types of vertebral compression fractures include biconcave (collapse of central portion of vertebral body) crush fractures (collapse of entire vertebral body). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).
Symptoms of Vertebral compression fracture
Compression fractures caused by injuries produce sudden onset of sharp and throbbing pain. Fractures caused by osteoporosis may cause very mild to severe pain in the back. Normally the pain is intense in standing posture and there is respite when lying down.
Vertebral compression fractures also lead to kyphosis and loss of height especially with the fractures associated with osteoporosis.
Sometimes a severely fractured bone can impinge on the spinal cord. Thus, numbness or tingling in limbs or other areas of the body may occur if the spinal cord is affected. This can impair sensation in the areas supplied by the damaged nerve tissue.
Doctor's evaluation of symptoms plays a major role in diagnosing compression fractures. Noting of complete history of the patient and clinical examination are necessary to determine the presence of vertebral compression fracture. When doctor suspects vertebral compression fracture, an x ray is ordered to confirm the diagnosis. If the X-Ray reveals a fracture, further imaging tests like CT scan and MRI are performed to rule out the involvement of spinal cord and also to understand the age of the fracture. A neurological exam may also be done to test for reflexes, muscle strength and sensory perception.
Treating Vertebral Compression Fracture
The conventional methods of treating vertebral compression fractures include pain medication, rest and bracing. While pain medication helps in alleviating the pain to some extent, back braces reduce the chance of further collapse of the bone, prevent deformity, and allow injuries to heal by taking the pressure off the fractured vertebral bone. Giving rest to the back by decreasing activities as much as possible helps in healing the fractures naturally and quickly.
There are also some minimally invasive methods used to treat vertebral fractures which are gaining popularity. Vertebroplasty and Kyphoplasty are two medical procedures that are increasingly being used to treat compression fractures. Here the fracture is treated by injecting a bone cement onto the collapsed bone through hollow needle. These are image-guided surgical procedures with minimum invasion that promise faster pain relief.
Further treatment also depends upon the underlying cause that is leading to vertebral fracture. If the osteoporosis is causing the bones to collapse, doctor may prescribe calcium and other bone strengthening supplements to avoid future compression fractures. If a tumor has caused compression fracture, more invasive surgery will be required remove sections of bone or tissue.
Septicemia is a life-threatening infection; where there is bacteria in the blood. This is a form of blood poisoning and the fatality rate is nearly 50%. It is also called a systemic inflammatory response syndrome or SIRS where the whole body is inflamed due to suspected infection. Severe sepsis leads to organ failure. Infections in the lungs, urinary tract or abdomen can lead to sepsis. Other conditions that can lead to septicemia are endocarditis, meningitis and osteomyelitis. Symptoms of sepsis begin with chills, high fever and rapid breathing. The condition worsens rapidly with hypothermia and low blood pressure setting in. There is very low urine output. Blood test for platelet count, CBC, blood gases and PTT are done. CSF culture is also done to diagnose sepsis. Treatment of septicemia involves hospitalization. IV fluids and medications are administered. Plasma is often given when clotting factors are affected. Dialysis and mechanical ventilation might be required to support the kidney and lung function.
Bibliography / Reference
Collection of Pages - Last revised Date: February 17, 2019