Infections in the spine are rare, but if they happen they can have disastrous consequences. Spinal infections can involve the disc, the bones or the nerves. They can be caused by bacteria, viruses or fungal infections. The most common type of spinal infection is spinal tuberculosis.
Spinal infections are usually blood-borne. Bacteria may spread into the vertebral discs and affect this area causing discitis. After disc destruction, the infection may spread into the vertebral bodies above and below the disc causing osteomyelitis. The bone, weakened by infection may also begin to collapse or crumble causing spinal deformity.
In some cases, the infection or crumbling bones may push into the area for the nerves or spinal cord which may cause neurologic symptoms including numbness, weakness, tingling, pain, or bowel or bladder dysfunction. If not diagnosed early, infections can cause spinal instability or spinal cord compression with injury to spinal cord and weakness in the legs.
Patient complaints often start with localized tenderness to the neck or back. Initially the pain is usually on movement but gradually patient starts having sever pain even at rest and even during sleep. Patient may start getting low grade fever, loss of appetite, weight loss and weakness and numbness in the legs.
Spinal infections can also occur following spine surgery (iatrogenic spinal infections) and usually present days to months after surgery
We need to get Xrays of Relevant portion of spine to look for bony destruction or instability. MRI spine is needed to look for any nerve compression or injury to the nerves. Usually we get MRI with contrast enhancement to exactly define the area of infection. Blood work up like blood culture, haemogram, ESR , CRP etc are needed to monitor response to treatment.
Treatment of most spinal infections is conservative with bed rest and intravenous antibiotics. In case of spinal deformity or instability or compression of spinal cord or nerves, urgent surgery is usually needed to stabilize the spine and remove the pressure over nerves
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