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The spine is made up of bones called vertebrae which surround and protect the spinal cord. These are separated by intervertebral discs which provide cushioning between the vertebral bones. A spinal infection may affect any part of your spine including the vertebral column, intervertebral discs or the soft tissues surrounding the spine.

Symptoms of Spinal Infection

Spinal infections are characterized by back or neck pain, depending on the site of the infection, which gradually becomes more severe and is not relieved by rest or medications. You may develop a fever, stiffness or headache. There may be increased wound redness or drainage if recent spine surgery was performed. As the disease progresses, the vertebral bones undergo damage and may compress the spinal cord and nerves. This can lead to neurological symptoms such as numbness, tingling or weakness in the arms or legs.

Causes of Spinal Infections

Spinal infections can be caused by bacteria or fungi which reach the spine through the bloodstream. The most common causes of spinal infections are bacteria called Staphylococcus aureus and Escherichia coli (E. coli). A spinal infection may develop following spine surgery or pelvic surgery, as the veins in the lower spine ascend through the pelvis. In some cases, intravenous drug abuse may also lead to spinal infection.

Diagnosis of Spinal Infections

Diagnosis of a spinal infection may be time-consuming if symptoms are not definitive, as your doctor will have to carefully rule out other conditions. Diagnostic tests may be performed including blood testing for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. High values of CRP and ESR indicate inflammation which occurs during a spine infection. X-ray imaging, computed tomography scan (CT or CAT scan) or magnetic resonance imaging (MRI) may be recommended. Your doctor may also order a computed tomography-guided biopsy (a small sample taken from the vertebra or disc space to identify the causative agent.) A blood culture may be performed if you have developed a fever.

Treatment of Spinal Infections

The first line of treatment involves intravenous (IV) administration of antibiotic or antifungal therapy. Treatment duration may be six to eight weeks or more, depending on your recovery.

However, surgery may be recommended under the following circumstances:

  • Your condition does not improve with conservative measures
  • A large area of vertebral bone is involved
  • You have significant neurological symptoms

The objectives of surgical treatment for a spinal infection include:

  • Debridement: cleansing and removal of the infected spine tissue/bone
  • Ensuring adequate blood flow to the infected tissue to promote healing
  • Restoring and maintaining spinal stability
  • Restricting the degree of neurological impairment

Spinal decompression involves relieving pressure on the spinal nerves to restrict neurological impairment.

Procedure for Spinal Infection Decompression

The procedure is performed under general anesthesia and intravenous antibiotics. The spine may be approached from the front or back, depending on the region of the infection and nerve compression. An incision is made to access the affected region of your spine. Your surgeon will use specialized equipment to assess the compressed nerves. Vertebral bone, discs or other spinal tissues may be removed to decompress the spinal nerves. Procedures are performed to stabilize the spine if necessary. The tissues are then closed and sutured.

Postoperative Management

You will continue to receive IV antibiotics in the postoperative period. You may be advised to wear a brace to support the spine as it heals. A long course of oral antibiotics is usually prescribed.

Risks and Complications

As with any surgery, spinal infection decompression also has some risks that include:

  • Allergic reaction to anesthesia
  • Blood clots
  • Infection
  • Bleeding
  • Nerve or tissue damage
  • American Academy of Orthopaedic Surgeons - AAOS
  • AO Foundation
  • North American Spine Society
  • Lumbar Spine Research Society
  • Orthopaedic Research Society