Spinal infections are serious medical conditions affecting the bones, discs, and surrounding soft tissues of the spinal column. If not promptly addressed, they can cause lasting damage and complications.
What Spinal Infections Are
A spinal infection refers to the presence of harmful pathogens within the spinal column. These infections can affect different areas, leading to specific classifications. Vertebral osteomyelitis is an infection of the vertebral bones themselves, often resulting from pathogens spreading through the bloodstream to the spine. This condition can weaken the bony structure, potentially leading to collapse or deformity.
Discitis involves an infection of the intervertebral disc space, the cushioning structures between the vertebrae. It can occur independently or as a consequence of vertebral osteomyelitis. When both the disc space and adjacent vertebral bodies are infected, the condition is often termed spondylodiscitis.
Spinal epidural abscesses form when pus collects in the space surrounding the dura mater, the protective membrane of the spinal cord. This collection can compress the spinal cord and nerve roots, leading to neurological symptoms.
Common Causes and Symptoms
Spinal infections commonly arise when bacteria or fungi spread to the spine from an infection located elsewhere in the body. This spread often occurs through the bloodstream, originating from sources like skin infections, urinary tract infections, or lung infections. Medical procedures, including spinal surgery, urological procedures, or even recent dental work, can also introduce pathogens to the spine. Intravenous drug use is another recognized risk factor due to the direct introduction of bacteria into the bloodstream.
People experiencing a spinal infection typically report localized back pain that is severe, persistent, and progressively worsens, often not improving with rest. This pain can be accompanied by systemic symptoms such as fever and chills. Unexplained weight loss is another symptom that may occur. As the infection progresses and affects the spinal cord or nerve roots, neurological symptoms can develop, including weakness, numbness, or tingling sensations in the arms or legs. Prompt medical attention is important if these symptoms are present to prevent irreversible damage.
How Spinal Infections Are Diagnosed
Diagnosing spinal infections begins with a thorough medical history and physical examination, assessing localized tenderness and neurological changes. Blood tests identify signs of inflammation and infection. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are common findings, although these markers are not specific to spinal infections alone. A complete blood count (CBC) may also show an elevated white blood cell count.
Imaging studies play a significant role in visualizing the affected areas of the spine. Magnetic Resonance Imaging (MRI) with contrast is often the preferred imaging method due to its ability to provide detailed images of the spinal soft tissues, discs, and vertebral bodies, allowing for early detection of infection and abscess formation. While X-rays can show later changes like vertebral collapse, they may not reveal early infection. Computed Tomography (CT) scans are useful for assessing bony destruction and guiding biopsy procedures. To definitively identify the microorganism causing the infection and guide targeted treatment, a biopsy or aspiration of the infected tissue is the definitive method. This sample is then sent for culture and pathological analysis.
Treating Spinal Infections
Treatment for spinal infections typically involves prompt and aggressive intervention to prevent further progression and potential complications. Long-term antimicrobial therapy, using either antibiotics for bacterial infections or antifungals for fungal infections, forms the primary approach. The specific medication is chosen based on the pathogen identified through biopsy or blood cultures. Initially, these medications are often administered intravenously for several weeks, followed by oral medication, with the total duration of treatment ranging from four to 12 weeks or even longer, depending on the infection’s severity and location.
Surgical intervention becomes necessary in certain situations, such as when neurological deficits occur due to spinal cord compression, when there is significant bone destruction leading to spinal instability, or if an abscess does not respond to antibiotic therapy. Surgical procedures can involve draining abscesses, removing infected tissue (debridement), and stabilizing the spine through fusion with instrumentation. Throughout the recovery phase, pain management and physical therapy are important components to help alleviate discomfort and restore spinal function.