Infection of the Spine

Infection of the spine is rare but is becoming increasingly common.

Risk factors associated with it are:

• Smoking
• Malignancy
• Previous irradiation
• Malnutrition
• Diabetes
• Immunodeficiency syndrome
• Recent infections, trauma and previous surgical procedures

The clinical presentation of a patient who has an infection is variable. The extent of the symptoms can be related to the general condition of the patient and the virulence of the offending pathogen. Most patients will have pain and usually the pain is relentless and present at rest. Muscle spasm may also be seen with the pain and the spasm may cause curvature of the spine, which we refer to as scoliosis or torticollis.

Diagnosis is done by a combination of taking careful history and examining a patient. An MRI scan will confirm the location of the infection. A definitive diagnosis is made by putting a needle into the area and sending the material for microbiology.

Treatment The vast majority of infection in the spine is treated conservatively with bed rest and appropriate antibiotics once the organism has been confirmed. There is still significant delay in the diagnosis of infection as often the patient presents with vague symptoms and it can take up to 12 weeks before an accurate diagnosis is made if the patient is not referred to the appropriate speciality.

Non-operative treatment:

• Tissue diagnosis by blood culture or aspirate
• 6-12 weeks of intravenous antibiotics
• Bracing to support the spine

With a combination of the above this is successful in about 75% of patients.

Indications for surgery:
• Progressive neurological impairment i.e. paralysis
• Presence of a spinal abscess
• Severe pain in the presence of external immobilisation
• Progressive spinal deformity
• Gross instability
• Failure of non-operative treatment

Surgery for infection usually involves excising the dead bone and then stabilising the spine with screws and cages. Please see case studies for examples.