Spinal Osteomyelitis as a Manifestation of Neonatal Sepsis: the Time Bomb

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Introduction Infection of the spine complicates neonatal sepsis very rare; to date there are only few case reports of this pathology. The purpose of the study is the analysis of non-specific spondylitis as a manifestations of neonatal sepsis. Material and Methods 9 cases of neonatal sepsis, operated for the kyphosis due to the spinal osteomyelitis. Results All patients were admitted to the hospital with the consequences of destructive lesions of the spine with no signs of active infection according to clinical and laboratory examinations. Sepsis occurred at the age of 5 days to 2.5 months. All cases had multiple foci of infection: pneumonia - 7/9, coxitis - 2/9, rib osteitis - 1/9, soft-tissue infection - 2/9, intestinal infection - 2/9. In 2/9 cases the microbiota was found - Staphylococcus sp. (from feces) and Klebsiella pneumonie (from the tracheobronchial tree). All patients received parenteral antibiotics. Spondylitis was diagnosed 3–12 months after the onset of the disease due to the progressive kyphotic spinal deformity. All cases had paravertebral and epidural abscesses with the compression of the dural sac, during prolonged antibiotic treatment the abscesses significantly reduced (6/9) or resolved (3/9). All children had total destruction of 2–3 vertebral bodies in the thoracic region (Th4 - Th11) that led to the formation of sharp angular kyphosis ranged 44–80 degrees of Cobb angle. At the time of surgery children were aged 7 to 19 months. All cases were neurologically intact. 8/9 patients had one-day surgical procedure - anterior fusion (4 using titanium mesh) and posterior instrumentation of the spine (⅞ – anterior and posterior approaches; ⅛ – only posterior), 1/9 had staged surgery (due to the cardiac problems – congenital heart defect). Postoperative neurologic status was intact in all children. Histologic exam of pathologic material showed signs of nonspecific inflammation of bone tissue in all cases. No microbiota, including mycobacteria, were found in the operating material (by microscopy and cultural methods). The absence of Mycobacterium tuberculosis DNA was confirmed by RT-PCR in 8/9 patients. Conclusion Infections of the spine as a manifestation of neonatal sepsis are rare, and are diagnosed after the onset of kyphosis. The disease is characterized by extensive destruction of the vertebral bodies and the formation of paravertebral and epidural abscesses without neurologic complication despite the pronounced compression of spinal cord in especially vulnerable to ischemic complications area of mid-thoracic spine. In the majority of patients verification of the causative microbial agent of sepsis and spondylitis was not possible. The angular deformity of the spine in young children due to the destruction of the vertebrae makes it necessary to rule out the spinal tuberculosis as the most common cause of acquired kyphosis in children. Surgical treatment of spondylitis as a sequela of neonatal sepsis is performed when the infection is under control. The goals of surgery are the anterior column reconstruction and kyphotic deformity correction.