Dr. Alex Jimenez, El Paso's Chiropractor
I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Please don't hesitate in calling us or myself if you have questions when the need to seek care arises. Call the office or myself. Office 915-850-0900 - Cell 915-540-8444 Great Regards. Dr. J

Spinal Infection Diagnostic Imaging Approach | El Paso, TX.

Pyogenic Spinal Infection

  • aka Spondylodiscitis and vertebral osteomyelitis overall are relatively infrequent and may present with bimodal distribution: children and adults >50’s
  • Occasionally considered as two separate entities due to variations in blood supply of pediatric vs. adult spines
  • Risk factors/causes: distant site of infection in the body (25-35%) e.g. oropharynx, urogenital infections, bacterial endocarditis, indwelling catheters, florid skin infections furunculosis/abscess etc.
  • Iatrogenic: operative (e.g. discectomy) interventional or diagnostic/therapeutic procedures
  • Penetrating trauma
  • Immunocompromised patients
  • Diabetics
  • Malnourished patients or patients with low protein
  • IV drug users
  • Chronic diseas patients, cnacer patients etc.

Potential Pathological Sequence

spinal infection diagnostic imaging el paso, tx.

Clinical Presentation

  • Back pain with or w/o high fever and other “septic” signs. Fever may only present in 50% children
  • Exacerbation of pre-existing back pain in post-surgical cases
  • Neurological complications in advanced cases of vertebral destruction and epidural abscess
  • Meningitis, septicemia etc.
  • Labs: Blood tests are unspecific, may or may not indicate elevated ESR/CRP, WBC
  • Diagnostic imaging is important but
  • If clinical suspicion is strong, prompt I.V. antibiotics are needed to prevent serious complications

Routes of Infection

spinal infection diagnostic imaging el paso, tx.
  • Infection routes to the spine are similar to bone in general
  • 3-distinct routes: 
  • 1) Hematogenous spread as bacteremia (most common)
  • 2) Adjacent site of infection (e.g. soft tissue abscess)
  • 3)Direct inoculation (e.g. iatrogenic or traumatic)
  • M/C organism Staph. Aureus
  • Mycobacterium TB (tuberculous spinal osteomyelitis) aka Pott’s disease can be presented in cases of re-activated or disseminated pulmonary TB

Mechanisms of Spinal Infection

spinal infection diagnostic imaging el paso, tx.
  • May vary depending on the patients’ age
  • In children, the IVD receives direct blood supply and can be infected directly spreading to adjacent bone and causing spondylodiscitis

In Adults

spinal infection diagnostic imaging el paso, tx.
  • The disc is avascular
  • Pathogens invade adjacent vertebral end-plates via end-arterial supply of the vertebral body that mayfacilitate infectiondue to slow turbulent flow
  • Organisms may then quickly gain access to disc substance rich in nutrients (discitis) often w/o mojor initial visible destruction to the bone
  • Thus, one of the earliest rad. findings of spinal infection is sudden reduction of disc height
  • Later end-plate irregularity/sclerosis may develop, subsequently affecting the entire adjacent vertebral bodies

Diagnostic Imaging

spinal infection diagnostic imaging el paso, tx.
  • Initially in most cases of MSK complaints, radiography is the 1st imaging step
  • Initially X-radiography is often unrewarding and may appear unremarkable for 7-10 days or presents with some subtle soft tissue changes (e.g. obscuration of Psoas shadows etc.)
  • Someof the earliest x-ray signs of pyogenic spondylodiscitis: sudden reduction of disc height (above arrow) during initial 7-10 days
  • Subsequently (10-20 days) some end-plate irregularity and adjacent sclerosis may be noted
  • In more advanced cases, subsequent vertebral destruction and collapse may occur
  • N.B. Reliable feature to DDx between spinal infection and metastasis is the preservation of disc height in thelatter

Discitis

spinal infection diagnostic imaging el paso, tx.
  • Discitis needs to be DDx from DDD (spondylosis)
  • An important DDx between discitis and DDD is lack of osteophytes (spondylophytes) and intradiscal gas (vacuum phenomenon) in DDD.
  • In fact, presence of intradiscal gas (vacuum phenomenon) virtually excludes discitis (except if gas-forming pathogens are involved)
  • Note: sudden disc narrowing with no appreciable spondylosis (above first image) is suspicious for infection (discitis)
  • MRI +C is required to evaluate suspected infection
  • N.B. 50-60% of pyogenic spondylodiscitis occur in the lumbar region

AP & Lateral Lumbar Radiographs

spinal infection diagnostic imaging el paso, tx.
  • Note severe disc narrowing and adjacent vertebral body destruction at L1-L2 in a 68 -y.o.-female with a known Hx of type 2 DM
  • Additional imaging modalities should be used to support the Dx
  • Final Dx: Pyogenic Spondylodiscitis

Sagittal T1 & T2 MRI

spinal infection diagnostic imaging el paso, tx.
  • Weighted MRI slices of a patient who had laminectomy at L4
  • MR imaging with gad contrast is the modality of choice for Dx of spinal infection
  • Early septic changes affecting the disc and adjacent vertebral end-plates are readily demonstrated as a low signal on T1 and high T2/STIR d/t edema and inflammation
  • T1 FS +C gad images show avid enhancement of the lesion due to granulation tissue around the phlegmon. Peripheral enhancement is also characteristic of an abscess.
  • Epidural extension/abscess can also be successfully detected my MRI
  • N.B. 50% of epidural abscess cases present with neurological signs

STIR & T1 FS +C Gad Sagittal MRI

spinal infection diagnostic imaging el paso, tx.
  • Marked septic collection and edema affecting L4-5 disc and vertebral body with some epidural extension and paraspinal soft tissue edema. Avid contrast enhancement is noted surrounding low signal foci within the bone and disc tissue, some gad. Enhancement is noted in posterior paraspinal muscles and dural spaces
  • Management: Dx of spondylodiscitis requires prompt I.V antibiotics. If instability and neurological complications develop referral to a Neurosurgeon is required

MRI Unavailable or Contraindicated

spinal infection diagnostic imaging el paso, tx.
  • Bone scintigraphy is very sensitive but non-specific for spinal infection but overall is of great value d/t higher sensitivity than x-rays and relatively low cost.
  • An area of increased flow with radiopharmaceutical uptake is characteristic but not specific sign of spondylodiscits
  • If neurological signs are present and MRI is contraindicated than CT myelography may be used

TB Osteomyelitis aka Pott’s Disease

spinal infection diagnostic imaging el paso, tx.
  • TB osteomyelitis is increasing d/t HIV and other immunocompromised states. Extrapulmonary TB m/c affects the spine and especially the thoracic spine (60%)
  • Radiographic Pathology: TB bacillus infects vertebral body and often spreads subligamentously. “Cold” paraspinal abscess collection may develop and spreads along fascial planes e.g. Psoas abscess. Disc spaces are preserved until v. late and skip areas are noted helping to DDx TB from pyogenic infection. Severe vertebral destruction aka Gibbus deformity may develop (>60-degree sometimes) and may become permanent. Neurologic and many regional complications may develop
  • Imaging approach: CXR with spinal x-rays 1st step that may be unrewarding but may potentially reveal VB destruction w/o disc narrowing. CT scanning is more superior than x-rays. MRI with gad C is a modality of choice
  • Management: isoniazid, rifampin, operative.
  • DDx: Fungal/Brucella infection, neoplasms, Charcot spine

Gibbus Deformity & Pott’s Disease

spinal infection diagnostic imaging el paso, tx.

Infection Of The Spine

Trauma Specialist Testimonies and Case Studies

Why Patients Choose Accidents Specialist to Treat Injuries
By Dr. Alexander Jimenez
1/ 40
  1. 1 Chiropractic Care on Whiplash | El Paso, Tx Chiropractic Care on Whiplash | El Paso, Tx 02:15
  2. 2 Car accident Injury Rehabilitation | El Paso, Tx Car accident Injury Rehabilitation | El Paso, Tx 02:19
  3. 3 *CAR ACCIDENTS* Chiropractor | El Paso, Tx (2019) *CAR ACCIDENTS* Chiropractor | El Paso, Tx (2019) 02:35
  4. 4 Recommended El Paso, TX Chiropractor Recommended El Paso, TX Chiropractor 03:43
  5. 5 Severe Back Pain Chiropractic Treatment El Paso, TX Severe Back Pain Chiropractic Treatment El Paso, TX 04:09
  6. 6 *CHRONIC* Pain Chiropractic Care | El Paso, Tx (2019) *CHRONIC* Pain Chiropractic Care | El Paso, Tx (2019) 02:38
  7. 7 *Car Accident Injury* Chiropractic Solution  |  El Paso, TX (2019) *Car Accident Injury* Chiropractic Solution | El Paso, TX (2019) 02:25
  8. 8 Chronic Pain Chiropractor | El Paso, Tx (2019) Chronic Pain Chiropractor | El Paso, Tx (2019) 02:07
  9. 9 Chiropractic Help on Car Accidents | El Paso, Tx Chiropractic Help on Car Accidents | El Paso, Tx 02:27
  10. 10 *Car Accident Injuries* Treatment  |  El Paso, TX (2019) *Car Accident Injuries* Treatment | El Paso, TX (2019) 02:18
  11. 11 Why Chiropractor for Auto Injuries? | El Paso, Tx Why Chiropractor for Auto Injuries? | El Paso, Tx 02:30
  12. 12 *Neck* Pain Chiropractic Care | El Paso, Tx (2019) *Neck* Pain Chiropractic Care | El Paso, Tx (2019) 02:59
  13. 13 Personal Injury Chiropractic Care | El Paso, Tx (2019) Personal Injury Chiropractic Care | El Paso, Tx (2019) 02:16
  14. 14 Most Effective Chiropractor | El Paso, Tx (2019) Most Effective Chiropractor | El Paso, Tx (2019) 03:16
  15. 15 Personal Injury Lawyers & Chiropractors | El Paso, Tx Personal Injury Lawyers & Chiropractors | El Paso, Tx 02:47
  16. 16 Top Chiropractor Near Me | El Paso, Tx (Best) Top Chiropractor Near Me | El Paso, Tx (Best) 02:29
  17. 17 Chronic Body Pain Recovery | El Paso, Tx Chronic Body Pain Recovery | El Paso, Tx 01:57
  18. 18 Chiropractic Pain Relief | El Paso, Tx Chiropractic Pain Relief | El Paso, Tx 01:56
  19. 19 Quiropractico Recomendado | El Paso, Tx Quiropractico Recomendado | El Paso, Tx 02:11
  20. 20 Most Recommended Chiropractor El Paso, Tx Most Recommended Chiropractor El Paso, Tx 02:04
  21. 21 El Paso, TX Shoulder Pain Chiropractic Treatment El Paso, TX Shoulder Pain Chiropractic Treatment 02:52
  22. 22 El Paso, TX Lower Back Pain Chiropractor Treatment El Paso, TX Lower Back Pain Chiropractor Treatment 05:51
  23. 23 El Paso, TX Chiropractic Treatment for Car Accidents El Paso, TX Chiropractic Treatment for Car Accidents 02:37
  24. 24 El Paso, TX 18 Wheeler Accident Chiropractic Treatment El Paso, TX 18 Wheeler Accident Chiropractic Treatment 02:23
  25. 25 Chiropractic Neck Pain Treatment El Paso, TX Chiropractic Neck Pain Treatment El Paso, TX 02:14
  26. 26 El Paso, TX Chiropractor 79936 El Paso, TX Chiropractor 79936 02:00
  27. 27 Sciatica Pain Treatment in El Paso, TX Chiropractic Care Sciatica Pain Treatment in El Paso, TX Chiropractic Care 01:56
  28. 28 El Paso, TX Chiropractic Care For Auto Accidents El Paso, TX Chiropractic Care For Auto Accidents 03:28
  29. 29 El Paso, TX Chiropractic Care Neck Pain Treatment El Paso, TX Chiropractic Care Neck Pain Treatment 04:47
  30. 30 El Paso, TX Chiropractor Auto Accident Injuries El Paso, TX Chiropractor Auto Accident Injuries 07:00
  31. 31 El Paso, TX Chiropractor New Patient Intake Form El Paso, TX Chiropractor New Patient Intake Form 02:05
  32. 32 Whiplash Chiropractic Massage Therapy El Paso, TX Whiplash Chiropractic Massage Therapy El Paso, TX 01:55
  33. 33 El Paso, TX Cervical Pain Treatment Chiropractic Care El Paso, TX Cervical Pain Treatment Chiropractic Care 05:08
  34. 34 18 Wheeler Accident Pain Treatment Chiropractor El Paso, TX 18 Wheeler Accident Pain Treatment Chiropractor El Paso, TX 02:23
  35. 35 Shoulder Pain Treatment El Paso, TX Chiropractor Shoulder Pain Treatment El Paso, TX Chiropractor 02:49
  36. 36 Back Pain Management El Paso, TX Chiropractor Back Pain Management El Paso, TX Chiropractor 05:51
  37. 37 Car Accident Injury Treatment El Paso, TX Chiropractor Car Accident Injury Treatment El Paso, TX Chiropractor 02:36
  38. 38 Auto Accident Injury Treatment El Paso, TX Auto Accident Injury Treatment El Paso, TX 02:15
  39. 39 Neck Pain Treatment El Paso, TX Chiropractor Neck Pain Treatment El Paso, TX Chiropractor 02:15
  40. 40 Slip And Fall Injury Treatment El Paso, TX Chiropractor Slip And Fall Injury Treatment El Paso, TX Chiropractor 01:55

Again, I Welcome You 👊🏻.

Our Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive, cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, practical strength training, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Rehabilitation Systems for all ages.

As an extension to effective rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high-performance exercises and advanced agility treatment options. We have teamed up with the cities premier doctors, therapist and trainers to provide high-level competitive athletes the possibilities to push themselves to their highest abilities within our facilities.

We’ve been blessed to use our methods with thousands of El Pasoans over the last three decades allowing us to restore our patients’ health and fitness while implementing researched non-surgical methods and functional wellness programs.

Our programs are natural and use the body’s ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Join us in improving your health for you and your family.

It’s all about: LIVING, LOVING & MATTERING! 🍎

Welcome & God Bless

EL PASO LOCATIONS

Central:
6440 Gateway East, Ste B
Phone: 915-850-0900

East Side:
11860 Vista Del Sol, Ste 128
Phone: 915-412-6677

Patient Testimonies & Cases Studies

Why Patients Choose Chiropractic
By Dr. Alexander Jimenez
1/ 25

Clinic Location 1

Address: 11860 Vista Del Sol Dr Suite 128
El Paso, TX 79936
Phone
: (915) 412-6677
EmailSend Email
Webwww.DrAlexJimenez.com

Clinic Location 2

Address: 6440 Gateway East, Building B
El Paso, TX 79905
Phone: (915) 850-0900
EmailSend Email
Webwww.ElPasoBackClinic.com

Clinic Location 3

Address: 1700 N Zaragoza Rd # 117
El Paso, TX 79936
Phone: (915) 850-0900
EmailSend Email
Webwww.ChiropracticScientist.com

Push As Rx Crossfit & Rehab

Address: 6440 Gateway East, Building B
El Paso, TX 79905
Phone
: (915) 412-6677
EmailSend Email
Webwww.PushAsRx.com

Push 24/7

Address: 1700 E Cliff Dr
El Paso, TX 79902
Phone
: (915) 412-6677
EmailSend Email
Webwww.PushAsRx.com

Call (915) 850-0900 Today!

Call Now Button