Spinal Infection Types, Causes, Symptoms, and Surgical Intervention

Most vertebral infections are osteomyelitis. Direct open spinal trauma, surrounding infections, and blood-borne bacteria can cause spinal infection.

Intervertebral disc space infections affect adjacent vertebrae. Adult hematogenous (spontaneous), childhood (discitis), and postoperative disc space infections exist. Spinal epidural abscess can develop around the dura, which surrounds the spinal cord and nerve root. The rare subdural abscess affects the space between the dura and arachnoid, the spinal cord's thin membrane. Intramedullary abscesses are spinal cord parenchyma infections.

Spinal Infection Types

Different types of spinal infections include:

• Vertebral osteomyelitis: Traumatic injuries, surgery, and bloodstream bacteria can cause osteomyelitis. This is the most common spinal infection.

• Discitis: Discitis is an infection of the spinal vertebrae's cushioning discs. The spinal discs between the vertebrae inflame during infection.

• Spinal Epidural abscess: Infections between the spinal cord lining and vertebrae cause spinal epidural abscesses. A severe epidural abscess can press on your spinal cord and cause weakness. Sometimes it causes a spinal cord stroke.

• Meningitis: Infection and inflammation of the meninges, which protect the spinal cord and brain, causes meningitis. These infections may be viral, bacterial, or fungal in nature.  Bacterial and viral meningitis spread.

Causes of Spinal Infection

Bacterial or fungal infections in other parts of the body can spread to the spine via the bloodstream. Staphylococcus aureus causes spinal infection, followed by E. coli. Urological procedures can cause spinal infections because lower spine veins rise through the pelvis. The lumbar region is most affected. Intravenous drug abusers have more cervical infections. Bacteria from recent dental procedures can enter the bloodstream and cause spinal infections.

Intervertebral disc space infections likely start in one of the contiguous end plates and spread to the disc. In children, the origin is disputed. Since most cultures and biopsies in children are negative, experts believe that childhood discitis may not be infectious but caused by partial epiphysis dislocation due to flexion injuries.

Symptoms of Spinal Infections 

Different types of spinal infections cause different symptoms, but pain is usually localized. Extra symptoms may occur in postoperative patients:

• Draining wounds

• Redness, swelling, or pain around the incision

• Spinal osteomyelitis

• Spinal tuberculosis 

• Severe back pain

• Chills and fever

• Weight loss

• Muscle cramps

• Urination pain or difficulty

• Neurological issues: arm/leg weakness, bowel/bladder incontinence

How to Diagnose Spinal Infections? 

Imaging and lab tests diagnose spinal infections. A pain control clinic may start with an x-ray if your infection is early. X-rays can show bone deterioration and disc height loss but not soft tissues like spinal discs. The space between vertebrae decreases as disc height decreases. Pain clinic in Plano may recommend an MRI to assess bone and soft tissue health.

Laboratory tests for spinal infections may include white blood cell count and inflammation markers. ESR and CRP are these markers. These indicators will be abnormally high in 85% of spinal infections. Your pain doctors in Fort Worth may also use a blood culture to isolate the pathogen causing your pain. Blood cultures identify pathogens in less than 50% of spinal infection cases.

Surgical Intervention

Spinal infection often requires long-term intravenous antibiotic or antifungal treatment and extended hospitalization. Immobilization may be advised for severe pain or spine instability. Antibiotics should be given after the infection organism is identified if the patient is neurologically and spinal column stable. Patients usually take antimicrobials for 6-8 weeks. Medication selection is based on patient circumstances, including age, for surgical treatment. When patients have minimal neurological deficits and surgical morbidity and mortality are high, nonsurgical treatment should be considered first. 

Nevertheless, surgical intervention may be required in the subsequent circumstances:

• Significant bone loss causes spinal instability.

• Neurological issues

• Clinically toxic sepsis caused by an antibiotic-resistant abscess

• Failure of needle biopsy to obtain cultures

• Intravenous antibiotics failing to cure the infection

Surgery's main objectives:

• Clean and remove infected tissue.

• Allow blood flow to infected tissue to promote healing.

• Instrumentation to fuse the unstable spine restores stability.

• Restore function or limit neurological impairment

• Once the patient needs surgery, imaging tools like plain x-rays, CT scans, and MRIs can help determine the level of surgery.

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