Spinal Infections

The vertebral column (bones), the intervertebral disks, the dural sac (the covering around the spinal cord), or the space around the spinal cord may become infected in a number of circumstances. The infection may be caused by bacteria or fungal organisms.

Causes & Risk Factors

Infections involving the spine include osteomyelitis, epidural abscess, and discitis. The first two conditions can coexist, since vertebral osteomyelitis is a major risk factor for the development of an epidural abscess. These conditions are more common in diabetics, alcoholics, intravenous drug addicts, immunosuppressed patients, patients with prior spinal column abnormality or trauma or invasive procedure, and patients with prior urinary tract and pelvic infections. About 20% of patients with an epidural abscess may have no systemic or local predisposing factor. Osteomyelitis often is not diagnosed until 8 to 10 weeks after initial presentation, which consequently leads to significant morbidity. Discitis or disc space infection is typically diagnosed 6 months after the onset of symptoms but may be more acute following disc excision.

Symptoms

• Unrelenting back pain +++++
• Fever +++ (50% of patients with vertebral osteomyelitis are afebrile at presentation)
• Patients with epidural abscess also may have radicular pain, leg weakness, sensory deficit, neck pain or stiffness, bladder dysfunction.

Signs

• Midline bony and percussion tenderness +++
• Discitis manifests as well-localized midline pain featuring limited motion and exquisite discomfort produced by any jarring movement. Most patients have referred pain of femoral or sciatic distribution.

Treatment

Antibiotic or anti-fungal medications treatment is required to treat spinal infections. The type and the duration of the treatment depends on the severity of the infection and the organism causing the infection.

Antibiotics or antifungal medications may be necessary intravenously (IV) and/ or orally. The duration of the treatment typically ranges from as short as 7-10 days, to as long as 6-12 weeks.

Surgery may be required for many postoperative infections to wash away much of the bacteria and infected tissue. In addition, surgery may be required in cases where there is evidence of instability of the spine as a result of the infection.