Spinal infections

Spinal infections:  symptoms, diagnosis, and treatment

One of the most difficult to diagnose, and yet dangerous conditions of the back and neck is a spinal infection. These infections can occur for many reasons, present symptoms that may be confused with other phenomena, and in roughly 20% of cases can be fatal. In this post, we will discuss the symptoms, diagnosis, causes and treatment of spinal infections. If you suspect that you or a loved one is suffering from a spinal infection, make an appointment with your physician immediately to discuss your concerns.  This is a potentially very serious condition.

Risk factors

Risk factors for developing a spinal infection include recent urological or spinal procedures, having an immune compromising condition or habits, and being elderly. Intravenous drug users, individuals with cancer or malnutrition, and those who have recently undergone long surgical procedures involving high blood loss or multiple surgeries at the same site may face an increased risk. Risk factors may be associated to infection location, as well. Intravenous drug users are more prone to cervical infections, while individuals who have undergone recent urological procedures are more likely to develop infections in the lower spine.

Symptoms

A spinal infection often begins with pain at the infected site, and in post-operative cases, may include wound drainage and tenderness, swelling, or redness near the incision. Vertebral osteomyelitis causes the most obvious symptoms – a cluster of fever, pain, weight loss, incontinence, painful urination and neurological deficits is common for this condition. Spinal canal infections are similarly aggressive in the symptoms they present, and generally progress through four stages.

  • Stage one – severe back pain, fever, localized pain or pain along the spinal column.
  • Stage two – pain radiating along the affected nerve or nerves.
  • Stage three – muscle weakness and bowel/bladder incontinence.
  • Stage four – paralysis.

Intervertebral disc space infections generally present with back pain that worsens with time, and cannot be relieved with prescription pain killers. The lack of other symptoms makes this condition very difficult to diagnose. For soft tissue infections, symptoms are not usually obvious. If an abscess is present, pain may radiate from the site into the flank and abdomen or through the hip.

Diagnosis

Diagnosis takes 1-6 months, due to the similarity of symptoms to other conditions. Diagnostic imaging and laboratory tests are used to determine the presence of spinal infections, with a strong preference for a combined use of MRIs, blood cultures, and reactive protein tests. In order to accurately and effectively treat a spinal infection, doctors must know the specific pathogen responsible.

Causes

Most often, spinal infections are caused by E. coli or Staph bacteria, although they can also be fungal. Childhood discitis results from partial dislocation of the epiphysis, and is not an infection at all.

Treatment

The proper treatment of spinal infections involves an intense intravenous administration of antimicrobial agents (antifungals or antibiotics) for a minimum period of 6-8 weeks. Patients are generally hospitalized during this period, and may be immobilized, as well. Medications vary based on case-specific factors including the pathogen responsible and the patient’s age, condition, and tolerance to different treatments. In extreme cases, surgery may be necessary.

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