Infections of the spine, although uncommon, are extremely destructive and can lead to spinal instability, neurologic damage including paraplegia and death if not properly treated. Spine infections that involve the vertebrae are called vertebral osteomyelitis. An infection of the disc is called discitis. an infection with pus within the spinal canal is called an epidural abscess. Most often, patients will present with only one or two of these clinical entities, yet some patients present with all three of these entities and are usually extremely ill. Infections of the spine can be caused by bacterial infection, fungus, or tuberculosis. The incidence of bacterial vertebral osteomyelitis, which is the most common form, is reported to be one in 250,000 and occurs most commonly in the region of the thoracolumbar spine.
How is it diagnosed?
The diagnosis of a spine infection is often delayed, primarily because the early signs and symptoms are subtle and clinicians do not initially suspect it. Patients with symptoms suggesting infection or tumor, such as unrelenting pain, night pain, fevers, chills, night sweats and weight loss must be appropriately evaluated with imaging and laboratory tests to confirm the diagnosis.
What are the treatment options?
The treatment of an infection of the thoracolumbar spine depends on the severity of a patient’s symptoms and severity of neurologic compression and bony destruction. Patients are initially referred for a fine needle aspiration (FNA) or closed bone biopsy and culture to ascertain the specific type of bacteria that is causing the infection. Patients in whom the biopsy or aspiration fails and the results are indeterminate may be considered for open biopsy. Patients are generally treated with strong antibiotics for four to eight weeks until the infection is eradicated. Patients are usually indicated for surgical debridement if there is spinal instability, significant deformity and/or neurologic deficit. A paravertebral abscess causing sepsis, or any sized epidural abscess, is often an indication for emergent surgical intervention. An anterior or posterior decompression and fusion, or combined anterior/posterior surgery, may be utilized depending on where the infection and neurologic compression is most prominent.