A spinal infection occurs when bacteria or, less commonly, other organisms infect the bones, discs, joints, spinal canal, or tissues surrounding the spine.
Spinal infections can occur in the cervical (neck), thoracic (mid-back), or lumbar and sacral (lower back) regions. Although the neurologic consequences can differ depending on the location, the causes, diagnosis, and general principles of treatment are similar throughout the spine.
Some spinal infections can be successfully treated with antibiotics alone. Others require urgent surgery when infection causes spinal cord or nerve compression, an abscess, spinal instability, or progressive neurologic dysfunction.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Osteomyelitis and Discitis
Vertebral osteomyelitis is an infection involving one or more of the bones of the spine.
Discitis is an infection involving an intervertebral disc.
Because the disc and adjacent vertebral endplates are closely connected, these conditions frequently occur together and are often called discitis-osteomyelitis or vertebral osteomyelitis-discitis.
Treatment therefore involves not only eliminating the infection but also determining whether the spine remains mechanically stable.
Post-Operative Spinal Infection
A post-operative spinal infection can develop after cervical, thoracic, or lumbar spine surgery.
The infection may involve:
- Skin and incision
- Muscles
- Deep soft tissues
- Bone
- Disc spaces
- Spinal implants
- The spinal canal
Some infections become apparent within days or weeks of surgery. Others may not become obvious until months later.
Possible warning signs include fever, drainage, increased pain, or neurologic symptoms.
Superficial infections may sometimes be treated with antibiotics and local wound care.
Deeper infections may require surgery
When screws, rods, plates, or cages are present, they do not automatically have to be removed.
If the instrumentation is necessary to maintain spinal stability, it can often be retained while the infection is treated.
Spinal Epidural Abscess
A spinal epidural abscess is a collection of infected material within the spinal canal but outside the dura surrounding the spinal cord and nerves.
An epidural abscess can occur anywhere along the spine.
The neurologic consequences depend heavily on its location.
Cervical Epidural Abscess
A cervical epidural abscess can compress the spinal cord and potentially affect both the arms and legs.
Thoracic Epidural Abscess
A thoracic epidural abscess can compress the spinal cord and may cause leg weakness, numbness, stiffness, or difficulty walking.
Lumbar Epidural Abscess
A lumbar epidural abscess can compress the spinal nerves or cauda equina and may cause leg pain, weakness, numbness, or bowel and bladder dysfunction.
A spinal epidural abscess causing progressive neurologic dysfunction can be a surgical emergency.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Facet Joint Infection
The facet joints are small joints located along the back of the spine.
Although uncommon, bacteria can enter one of these joints and cause septic facet arthritis, also called a facet joint infection.
The lumbar facet joints are affected most often, although infection can occur in the cervical or thoracic spine.
Possible symptoms are mostly predominantly pain and fever
The infection can occasionally spread from the facet joint into the surrounding muscles or spinal canal.
Many facet joint infections can be treated successfully with antibiotics.
Image-guided aspiration may occasionally be used to identify the responsible organism.
Drainage or surgery may be necessary.
Paraspinal Infection
A paraspinal infection develops within the muscles and soft tissues surrounding the spinal column.
An abscess may develop within these tissues.
Patients often present with fever and pain.
Treatment may include antibiotics and drainage of an abscess when necessary.
Drainage can sometimes be performed using an image-guided needle or catheter. Larger or more complicated infections may require surgical drainage.