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Infection of the Spine 2017-03-27T20:40:39+00:00

INFECTION OF THE SPINE

A spine infection can be quite serious, if not treated early and properly.  The infection may affect the spinal vertebrae themselves, which is called osteomyelitis. It can also affect a spinal disc between the vertebral bones – discitis – and it can invade the spinal canal and the protective sheath around the spinal cord – epidural abscess.

Most commonly, the germs that cause spinal infections are bacteria, such as Staphylococcus Aureus, and fungal organisms.  Occasionally a virus can be the culprit.

When a spinal vertebra is infected, the bone might be partially “eaten away,” changing its shape and decreasing its strength.  In this case, surgical procedures, like spinal fusion, can be done to stabilize the area to allow for safer movement and to prevent fracture.

Osteomyelitis is the most common spinal bone infection, and these vertebral body infections occur often in the lumbar spine because of the blood flow to this region of the spine. Tuberculosis infections have a predilection for the thoracic spine (mid-back), and intravenous drug abusers are more likely to contract an infection of cervical spine (neck).

Causes of Spine Infections

A spinal infection may occur following surgery or spontaneously in patients with certain risk factors. Risk factors for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, intravenous drug use, diabetes, and obesity. 

Surgical risk factors include the following: a long surgical time, instrumentation, such as scoping the urinary tract or colon, and re-operations. Infections occur in about 5% of surgical cases, despite the numerous preventative measures that are taken. The likelihood of an infection increases with the number of operations in an area. Most postoperative infections occur between three days and three months after the time of surgery.

Symptoms of Spine Infection

The symptoms of a spinal infection include fever, chills, headache, neck stiffness, pain, wound redness and tenderness, and wound drainage. In some cases, the infection and inflammatory chemicals affect the function of nerves.  This may bring some weakness, numbness or tingling sensations in the arms and/or legs. The symptoms may be severe or mild.

Diagnosing a Spine Infection

The diagnosis of a spinal infection begins with the doctor’s taking your health history and conducting a physical examination. Your doctor should ask questions to screen for the spinal infection risk factors.

If your doctor suspects a spine infection, they may order a series of tests. These tests usually include plain X-rays, computerized tomography (CT or CAT) scans or MRI scans. In some cases, further specialized testing is required when the diagnosis is still in question.

Your doctor will want to obtain cultures to determine the type of bacteria or fungus that is causing the infection. Blood cultures are often obtained to screen for evidence of infection. Cultures of your wound or the area of infection may be taken. In cases of deep infections of the vertebrae (bone) or the intervertebral disc, a needle culture may be required. This is often done by X-ray guidance with local anesthetic medication given at the needle entry site.

Treatments for Spine Infection

Treatment for a spinal infection usually includes a combination of intravenous antibiotic therapy, bracing, and rest.

Because the common culprit is Staphylococcus Aureus bacteria, antibiotics are generally effective. The intravenous antibiotic treatment usually takes about four weeks, and then is typically followed by about two weeks of oral antibiotics. For infection caused by tuberculosis, patients are often required to take three drugs for up to one year.

Bracing is recommended to provide stability for the spine while the infection is healing. It is usually continued for 6 to 12 weeks until either a bony fusion is seen on X-ray, or until the patient’s pain subsides. A rigid brace works best and only needs to be worn when the patient is actively moving at work, exercise, or hobby; in other words, at risk for injuring the spine.

In severe cases of spinal bone destruction, an orthopedic surgeon may recommend surgery to clean out the infection and stabilize the spine.

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