Spinal infections include spondylitis, discitis, spondylodiscitis, and epidural abscess and are caused by various microorganisms. Bacterial infections of the spine are the most common type of infection in this group. Infections are often carried through the blood stream into vertebrae. For infection, some groups of patients are at risk such as those who smoke, have malnutrition, or AIDS or a similar disease causing immune system disorder, receive chemotherapy, transplant patients, patients with diabetes, those who abuse drugs, and those who have undergone urinary system operation. An infection can occur after the surgery.
Discitis is an infection in the intervertebral disc space. Discitis primarily occurs in childhood depending on the build-up characteristic related to blood supply of the disc. It usually appears as an infection in adults developed after a discectomy.
Bacterial Vertebral Osteomyelitis
Bacterial vertebral osteomyelitis is the infection of bony structures of the spine by bacteria , and secondarily disc space, adjacent soft tissues and epidural space can be affected. The most common cause is the bacteria called staphylococcus aureus.
Granulomatous Vertebral Osteomyelitis
The most acommon granulomatous infection involving the spine, is a disease caused by Mycobacterium tuberculosis (tuberculosis) microorganism. Bacteria, e.g. Actinomyces, Nocardia, and Brucella, and fungi, e.g. Coccidioides, Blastomyces, Aspergillus, and Cryptococcus, can also cause granulomatous infection.
Tuberculosis is still an important disease and the cause of death in undeveloped countries. 50% of patients have involvement of the spine. The spinal infection often occurs by spread of bacteria through blood stream from another source such as the lungs or genitourinary system.
Spinal Epidural Abscess
Despite current advanced diagnostic and treatment options, spinal epidural abscess is a disease that can result in death or a serious disability. The abscess often involves 3 or 4 vertebrae and mostly appears in the lumbar region. A spinal trauma, previous infection in another organ, and medically concomitant diseases can be the preparatory factors.
Symptoms of Spinal Infections
The most important symptom of spinal infections is a severe pain developed without a history of trauma. Making a diagnosis can be therefore delayed. Symptoms of the infection include fever, fatigue, headache, cervical stiffness, swelling of surgical wound, sensitivity, redness, and discharge. The patients sometimes can feel numbness of arms and legs, loss of sensation, and weakness of muscle strength. Progressed and untreated cases can experience urinary and faecal incontinence, and complaints leading to paralysis.
The blood tests and radiography could be normal at initial stage of the disease. However, higher sedimentation rate, CRP and white blood cell could be observed in later stages. Magnetic resonance imaging (MRI) is most precise radiological diagnostic method.
The active microorganism should be determined in treatment of spinal infections. For this, a biopsy from the infected area should be primarily performed. Appropriate antibiotic treatment is started once the type of infection has been identified in vitro. Rest and use of a corset is often included in the treatment.
The basic objective of the treatment is to eliminate the organism and to ensure functional stability of the spine, in other words, to avoid injuries of the spine due to normal forces. The infected area may be required a surgical drainage depending on the type, stage of the disease; clinical picture of the patient, and active microorganism. Early surgical interventions in case of patients with osteomyelitis of vertebra in particular and infections producing neurological damage may be required in order to avoid progressive paralysis.