Spinal Infection

What are the Causes of Spinal Infections?

Spinal infections can be caused by:

Spinal infections usually arise through one of three  routes:

1. Hematogenous spread: This is the most common method, where infections spread through the bloodstream from distant sources, such as the urinary tract, skin, or respiratory tract.
2. Direct external inoculation: This occurs during spine surgeries, injuries, or medical procedures, like lumbar punctures or spinal pain injection
3. Contiguous spread : This involves the infection spreading from nearby tissues that are already infected.

Spinal infections can be caused by either a bacterial or a fungal infection

What are risk factors for spinal infection

• Recent spinal surgery or invasive procedures
• A weakened immune system due to conditions like diabetes or cancer.
• Intravenous drug use
• Poor hygiene or unsterile surgical environments.

What is the Anatomy of Spinal Infections?

Spinal infections can affect various parts of the spine:

• Vertebrae: Infection of the vertebrae itself can lead to vertebral osteomyelitis.
• Intervertebral Discs: Infection of the discs is known as discitis.
• Epidural Space: Infection in the space around the spinal cord can cause epidural abscesses.

What are the Common Symptoms Associated with Spinal Infections?

Common symptoms of spinal infections include:

• Back Pain: Often severe and persistent.
• Fever: Common in bacterial infections.
• Neurological Symptoms: Such as numbness, weakness in the limbs.
• Spinal Tenderness: Pain or tenderness upon touching the spine.
• Weight Loss: Unexplained weight loss may occur.
• Sweats or Chills: Particularly in acute infections
• Incontinence of bowels and/or bladder
• Night sweats or general malaise

If I Have a Spinal Infection, Should I See a Doctor Always?

Yes, you should seek urgent medical attention if you suspect a spinal infection.

Delaying in treatment may lead to the worsening of the infection, potentially causing irreversible damage to the bone and soft tissue structures around the spine.

Can I Treat My Spinal Infection with Household Remedies?

No, spinal infections require professional medical treatment. Household remedies are not sufficient and can lead to severe complications. It is essential to get proper medical care, which may include antibiotics or surgery.

What are the Treatment Options for Spinal Infections?

Treatment options for spinal infections may include:

• Pain management – over the counter medication or parental administration
• Antibiotics or Antifungals: To target the infection, depending on the causative organism.
• Surgery: To drain abscesses or remove infected tissue , decompress the spinal cord if necessary.
• Supportive Care: Including fluids, nutrition, and monitoring for complications
• Rehabilitation –  Rehabilitation and physiotherapy after treatment are crucial for restoring mobility and preventing future complications.

When surgery is indicated:

Instability:

• If the infection has caused significant damage to the vertebrae, leading to spinal instability, surgery may be necessary to stabilize the spine with instrumentation like rods and screws, according to a spine surgeon. 
• Neurological Deficits:
• If the infection is compressing the spinal cord or nerves, causing weakness, numbness, or other neurological problems, surgery may be needed to relieve the pressure. 

Abscess Formation:

• If a spinal abscess (collection of pus) develops, surgery is often required to drain the abscess and remove the infected tissue( can be performed under image guidance CT with minimally invasive techniques)

Failed Conservative Treatment:

• If antibiotics and other non-surgical treatments are not effective in controlling the infection, surgery may be necessary to debride  the infected area and identify  the source of the infection. 

Deformity:

• If the infection leads to significant spinal deformity, like kyphosis (abnormal curvature), surgery may be needed to correct the deformity and stabilize the spine. 

Postoperative Infections:

• Patients with postoperative spinal infections, especially those with infected implants, often require surgical debridement and implant removal. 

Surgical Goals:

• Debridement: Thoroughly removing infected tissue and bone. 
• Decompression: Relieving pressure on the spinal cord or nerves. 
• Stabilization: Restoring spinal stability using instrumentation like rods, screws, and bone grafts. 
• Wound Closure: In some cases, the wound may need to be left open initially and packed with dressings that are changed frequently until healing occurs. 

Minimally Invasive Options:

• In some cases, minimally invasive techniques can be used to access and treat the infection, such as percutaneous endoscopic debridement or minimally invasive spinal fixation ( to stabilise the spine)

What can I expect after surgery

Patients are mobilised depending upon clinical condition with braces , usually discharged after 5-6 days. Follow up after 7 to 10 days , to see the wound healing .

Would also require certain blood test , antibiotics (oral and parental) for brief period based on how infection is responding along with rehabilitation