Introduction
Spinal infections are classified according to their anatomical location. They are the vertebral column, intervertebral disc space, spinal canal, and adjacent soft tissues. Infections can occur after surgery and can be caused by bacteria or fungi. Most postoperative infections occur between three days to three months following surgery. The most common type of vertebral infection is vertebral osteomyelitis. It can develop due to direct open spinal trauma, infections in the surrounding areas, or bacteria that spreads from the blood to a vertebra. Infections of the intervertebral disc space affect the space between adjacent vertebrae. There are three types of disc space infections. They are adult hematogenous (spontaneous), childhood (discitis), and postoperative infections.
What Are the Causes of Spinal Infections?
A bacterial or fungal infection can cause spinal infections. Infections in any other body part can spread through the bloodstream to the spine. Staphylococcus aureus is the most common cause of spinal infections, followed by Escherichia coli. The veins in the lower spine come up through the pelvis, and spinal infections can occur after a urological procedure. The lumbar region is often an affected area of the spine. Intravenous drug users are more likely to develop cervical infections. Infections in the intervertebral disc space begin in one of the contiguous end plates and then spread to the disc.
What Are the Symptoms of Spinal Infections?
The symptoms of spinal infections depend upon the type of spinal infection, but the pain is usually localized at the site of the infection. These additional symptoms may be present in patients:
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Chills.
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Neck pain.
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Weakness of arms.
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Drainage of the wound.
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Swelling.
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Tenderness.
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Back pain.
What Are the Different Types of Spinal Infections?
Different types of spinal infections are as follows:
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Osteomyelitis - Osteomyelitis, also known as spondylodiscitis, is a common spinal infection that affects adults. The vertebrae are affected. This condition will also affect the intervertebral discs located between the vertebrae. Bacteria, parasites, or fungi can spread into the backbone and cause this condition. They can enter the spine through various routes, including surgery, spread from the surrounding tissues, and infections in the blood. The most common symptom of osteomyelitis is a pain in the spine, specifically backbone pain, that worsens at night and does not go away with time. This is one of the symptoms of osteomyelitis. Because pain is frequently the only symptom, this condition is difficult to diagnose. People may also have difficulty moving their limbs sometimes, but this is only if the spinal cord has also been compressed.
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Discitis - This infection can occur following surgery or on its own. Staphylococcus aureus is the most common cause, and other bacteria, such as Streptococcus, can also cause it. Discitis can develop due to a urinary tract infection or pneumonia spreading through the bloodstream. Fever, radiating pain throughout the body, pain when moving the spine, and chills are all symptoms of discitis. Children, particularly young children, and teenagers can be affected by discitis. Most people with this condition also have other medical conditions, such as diabetes mellitus. Complications that can develop due to discitis are spinal deformity and neurological problems.
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Meningitis - Meningitis can cause many issues if not treated properly and on time. It spreads quickly and causes swelling around the brain and spine. meningitis can be contagious or noncontagious. Drugs, disorders, viruses, and other organisms can cause it. The brain tissue remains unaffected when a virus causes meningitis. If one has bacterial meningitis, the brain may be affected. Meningitis causes symptoms similar to viral infections, such as fever and muscle aches (myalgias). Specific meningitis symptoms are fever, stiff neck, and headache.
How Are Spinal Infections Diagnosed?
A combination of imaging studies and laboratory work can be used to diagnose spinal infections. The doctor will most likely start with an X-ray in the early stages of an infection. Although X-rays cannot reveal soft tissues (such as spinal discs), they can reveal bone deterioration and disc height loss. In this case, a decrease in space between two vertebrae represents a loss of disc height. The doctor may recommend an MRI (magnetic resonance imaging) to obtain information about soft tissue and bone health. A white blood cell count or inflammation markers may be examined in the laboratory to help diagnose a spinal infection. These markers are the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These indicators will be abnormally high in 85 percent of all spinal infection cases. The doctor may also use a blood culture to isolate the specific pathogen causing the pain. However, blood cultures only identify pathogens in less than half of spinal infection cases.
How Are Spinal Infections Treated?
Treatment of spinal infections includes:
1. Nonsurgical Treatment - Spinal infections frequently necessitate long-term intravenous antibiotics or antifungal therapy, which can result in the patient being hospitalized for an extended period. Immobilization may be required when there is significant pain or the possibility of spine instability. If the patient is structurally and neurologically stable, antibiotic treatment should be started once the organism causing the infection has been identified. For six to eight weeks, antimicrobial therapy is typically administered to patients. The type of medication is determined on an individual basis based on the patient's specific circumstances, including age.
2. Surgical Treatment - When patients have minimal or no neurological deficits, surgical intervention's morbidity, and high mortality rate, nonsurgical treatment should be considered first. However, surgery may be indicated if the following conditions exist:
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Significant bone loss causes spinal instability.
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Deficits in neurological function.
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Sepsis with clinical toxicity caused by an unresponsive abscess to antibiotics.
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The inability of needle biopsy to obtain required cultures.
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The inability of intravenous antibiotics to eradicate infection.
The primary goals of surgery are as follows:
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Clean and remove the infected tissue.
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Allow adequate blood flow to the infected tissue to aid in healing.
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Restore spinal stability by fusing the unstable spine with instrumentation.
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Restriction of neurological impairment or restoration of function.
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Once it is determined that surgery is required, imaging tools such as plain X-rays, CT (computed tomography) scans, or MRI can help further pinpoint the level at which surgery should be performed.
Conclusion
A spinal infection is a rare but often fatal disease caused by bacteria, fungi, or viruses invading the spinal tissues, including the vertebrae, spinal discs, meninges, spinal canal, and spinal cord. Proper and timely follow-up is necessary to ensure that the spinal infection has been controlled and that the treatment protocol works.