What is spinal infection?
The spinal cord and its surrounding structures can become infected due to bacteria or fungi in the following regions:
- Vertebral column (bones)
- Intervertebral discs
- Dural sac (covering around the spinal cord)
- Space around the spinal cord
The different types of spinal infections are as follows:
- Vertebral Osteomyelitis – The most common form of vertebral infection, vertebral osteomyelitis can result from open spinal trauma, infection of surrounding areas, and bacteria that spread to a vertebra.
- Intervertebral disc space infection – Infections of the space between adjacent vertebrae can be of three types:
- Adult haematogenous (spontaneous)
- Discitis (childhood)
- Postoperative infection
- Spinal canal infection – Infection of the spinal canal includes:
- Spinal epidural abscess (an infection that develops in the space around the dura, which is the tissue that surrounds spinal cord and nerve root).
- Subdural abscess (rarer; affects the space between the dura and arachnoid, which is the thin membrane between the dura mater and pia mater).
- Intramedullary abscess (infection within the spinal cord parenchyma).
What are the causes of the disorder?
Spinal infections can be caused by bacterial or fungal infections in a part of the body that gets carried into the spine through the bloodstream.
The most common agents of bacterial infection are Staphylococcus aureus and Escherichia coli. Spinal infections may also occur following a urological procedure, as veins in the lower spine run up through the spine.
Most common area of the spine that is affected with infection is the lumbar region. Intravenous drug abusers are more prone to infections in the cervical region. Spinal infections may also occur following surgery or spontaneously in some patients with high risk factors.
Risk factors for spinal infection includes immune suppression, poor nutrition, human immunodeficiency virus (HIV) infection, diabetes, cancer and obesity. Surgical risk factors include instrumentation, re-operation and long surgery.
What one needs to know about symptoms or signs?
Common symptoms of spinal infection include pain that develops slowly over time, fever, chills, unexplained weight loss and night pain. Some patients can experience these symptoms for weeks or months before getting diagnosed with spinal infection.
Symptoms based on the type of spinal infection are as follows:
- Vertebral osteomyelitis – Severe back pain, fever, chills, muscle spasms, painful urination, neurological deficits.
- Spinal canal infections – severe back pain, local tenderness in the spinal column, nerve root pain in the infected area, voluntary muscle weakness (bladder and bowel dysfunction), and paralysis.
- Adjacent soft-tissue infections – Flank pain, abdominal pain or a limp in case of paraspinal abscess, and radiating pain from the hip to the thigh in case of psoas muscle abscess.
What are the screening tests and investigations done to confirm or rule out the disorder?
The biggest challenge in diagnosing spinal infection is detecting it early before serious morbidity occurs. Diagnosis may take anywhere between one to six months, and many patients do not seek treatment till symptoms become very severe. Diagnosis is carried out in the following ways:
- Laboratory tests – Spinal infection can be detected through blood tests that test acute-phase proteins, like erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. These tests can identify inflammation in the body.
- Blood culture & biopsy – Biopsy sampling of vertebra and disc space through computed tomography help identify the pathogen involved in the spinal infection.
- Imaging tests – Imaging studies can pinpoint the location and extent of a lesion. Different imaging techniques are employed for diagnosing different infections:
- Vertebral osteomyelitis – Computed tomography (CT) scan for determining degree of bone destruction, and magnetic resonance imaging (MRI) can determine soft tissue involvement.
- Intervertebral disc space infections – Plain x-rays and MRI scans can show discitis.
- Spinal canal infections – MRI with Gd enhancement is used for creating high-resolution images of the neural structures.
- Adjacent soft tissue infections – MRI and CT scan is carried out.
What treatment modalities are available for management of the disorder?
Nonsurgical management of spinal infections consists of antibiotic and anti-fungal medications, the type and duration of which varies with the severity of the infections and the causal infection. Antibiotic treatment may last from 7-12 days to 6-12 weeks and is given either orally or intravenously.
Sometimes, doctors administer a special intravenous line called the central line for a longer course of antibiotics. Doctors may also recommend a brace to support the spine during the healing process.
Surgery is considered in the following situations:
- Significant involvement of the bone
- Neurological deficitis
- Sepsis caused by abscess that is unresponsive to antibiotics
- Failed needle biopsy
- Failure of intravenous antibiotics in removing the infection
Surgery may vary from simple washing out of the wound and re-closing after removal of the infected tissue, or leaving packing dressing in place if the wound cannot be closed. The dressing is changed two to three times in a day till it heals over the next few weeks.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Patients recovering from spinal infection require regular blood tests and x-rays to ascertain if the infection is responding to treatment. Patients suspected of spinal infection must seek treatment at the earliest as also patients showing symptoms of neurologic compromise.
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