Non – Surgical Treatment
Non-operative treatments are usually given alongside surgical treatment options in cases of both spine tumors and spinal infections. For spinal infections, basic treatment involves use of antibiotics and intra-venous injections to get rid of the bacteria or other micro-organisms that are causing the disease, use of braces to support the back and rest for the patient to prevent further injury. Most cases of infections in the world care caused by Staphylococcus Aureus which is relatively sensitive to antibiotics and can easily be gotten rid of. However, in India, Tuberculosis infections may spread to the spine and according the the type of bacteria present, there may be moderate to severe drug resistance proving it difficult to remove.
Spinal tumors are treated with appropriate chemotherapy or other drugs that are recommended by a competent oncologist.
If pain is excess, patients are also prescribed pain killers. However, non-operative treatments are not a remedial measure. If the spread of the infection of the tumor is excess and the surgeon feels that antibiotics will not heal it completely, surgery might by required to scrape of the infected area and remove the micro-organisms.
Spinal Decompression / Fusion / Grafting
The surgeries listed above are merely symptom management procedures and do not actually have any influence on the strength and extent of the infection. These surgeries are performed in response to the changes that occur in the spinal anatomy due to the infection.
Spinal decompression surgery needs to be performed in cases of spinal infection where an epidural abscess places pressure on the neural elements. Because surgical decompression often destabilizes the spine further, instrumentation and fusion are also frequently included to prevent worsening deformity and pain. In cases where bone graft is required, bone graft from the patient’s hip is usually extracted and can be used in the front of the spine, where most of the infection is located, rather than metal implants. Bone grafting for anterior column support (in the front of the spine) is usually followed by posterior instrumentation (in the back of the spine), which places the spinal implants in a relatively clean environment and decreases the chance of a bacterial infection around them.
The surgeon will usually resort to a debridement procedure if the antibiotic and injection therapy has failed. This is not a merely symptom treatment procedure, but is involved with clearing of the infectious agents that are causing damage to the spine.
In this procedure, a small surgical incision is taken on the back. All the infected tissue is scraped and is removed from the body. After removal, the remaining tissue is washed with a clear liquid to get rid of any other microorganisms that might be attached to the surrounding tissues. Then, the surgeon will place drains in that wound area to remove any liquid that might be produced due to the other tissues and to drain any other microorganisms that might be present. The surgeon then closes up the incision.
Spinal Tumor Treatment
The treatment of spinal tumors is a rather complex one and depends on a multitude of factors. The goal of the surgery is usually to remove the complete tumor and restore and preserve all neurological function. The spinal cord and nerves are highly sensitive and avoiding damage to these structures is a critical part of surgery. Monitoring techniques may be used throughout the surgery to determine the function of the spinal cord as the tumors are being removed. If the tumor cannot be completely removed (e.g. if it adheres to many spinal nerves), post-operative radiation therapy may improve outcome in some cases. If the tumor is metastatic, chemotherapy may also be helpful. Following the surgery, it may take some time for the nerves to fully heal. Usually rehabilitation and time significantly helps improve a patient’s neurological function.
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