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Spinal
Infections
Overview/Definition
Symptoms
Potential Causes
Diagnosis
Treatment Options
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Overview/Definition
Although fairly rare, spinal infections vary significantly. Among the most
common are osteomyelitis, discitis, and epidural abscess. Osteomyelitis is
an infection of the vertebral bone of the spinal column. Discitis, an infection
of the disc space, involves an inflammatory lesion of the intervertebral
disc. An epidural abscess is an infection that develops in the space around
the dura, the tissue that surrounds the spinal cord and nerve root.
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Symptoms
Osteomyelitis patients are generally ill with fever and severe back pain.
Systemic symptoms such as chills, weight loss, difficult or painful urination,
and intolerance to light may be present. If the disease has progressed, neurological
symptoms may also be present. If there has been prior surgery, there may
also be drainage from a wound or incision.
Discitis patients have few symptoms at first, but go on to develop severe
back pain. Generally, children do not have elevated temperature or complain
of severe pain, but will refuse to flex the spine.
Epidural abscess symptoms are generally less obvious, often consisting of
little more than a pins and needles sensation or mild weakness.
Symptoms of post-operative infections include drainage from the wound, severe
pain, fever, hematoma, and redness and swelling at the site of the incision.
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Potential
Causes
Osteomyelitis can be caused by either a bacterial or a fungal infection elsewhere
in the body that has been carried into the spine through the blood stream.
The most common source is a bacterium called Staphylococcus aureus. The veins
in the lower spine come up through the pelvis. For this reason, spinal infections
may occur after a urologic procedure (e.g., cystoscopy). Tuberculosis, although
much more prevalent in underdeveloped countries, can also cause this type
of infection.
Although most researchers believe discitis to be caused by infection, the
cause has been the subject of some debate. The infection probably begins
in one of the contiguous end plates, which leads to an infection in the disc.
Due to improved surgical techniques and the use of peri-operative antibiotics,
post-operative spinal infections have become increasingly rare. However,
a small percentage of such cases still occur.
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Diagnosis
MRI is usually the diagnostic tool used to confirm spinal infections. It
can determine the presence and extent of any infection and the presence of
spinal cord compression.
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Treatment
Options
Long-term antibiotic therapy, including both oral and intravenous therapies,
is usually required for the treatment of osteomyelitis. If the vertebrae
continue to deteriorate and if conservative treatments have been exhausted,
surgery may be required to remove the infected fusion and stabilize the spine.
Most doctors treat discitis with plaster cast immobilization, an effective
treatment in most cases. In some cases, antibiotics are also prescribed.
The treatment for an epidural abscess involves the removal of the infected
tissue and administration of antibiotics.
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