Spinal Infection

Post-operative infection

The spine may be infected when organisms enter the blood stream from cuts in the skin, other sites of infection such as tooth abscess, or after spinal surgery. Unrelenting and increasing back or neck pain is the most common symptom when the infection is restricted to an intervertebral disc or vertebral bones. Presentation is commonly through the emergency department of a hospital. Successful treatment with antibiotics may take many months and correspondingly, the pain may also take a long time to settle down.

In some cases, paralysis can develop if a spinal abscess forms that compresses the spinal cord or nerves. This is a serious situation that is treated in hospital with admission through the emergency department and often requires urgent surgery as well as long term antibiotics. Even with the best treatment, there is a risk of permanent paralysis.

Post-operative infection is a risk with any spinal procedure. Symptoms are increasing and unrelenting pain a week or two after surgery, when normally pain should be improving. The wound itself may become red and swollen and sometimes infected fluid may discharge (but not all fluid discharges are infected). In such situations, it is important to see the original treating surgeon urgently, as intensive treatment will be required. Secondary surgery to drain the infection is often needed, as well as long term antibiotic therapy.

Medical terminology:

  • Discitis = infection of an intervertebral disc
  • Vertebral osteomyelitis = infection of a vertebra
  • Epidural abscess = abscess in the spinal canal with the potential to cause paralysis
  • PICC line = ‘peripherally inserted central catheter’; is a specialised intravenous catheter often used to give long term intravenous antibiotics in the hospital or at home
  • Infectious diseases specialist = a specialist physician who provides expert management of antibiotic therapy for complex infections; often works in a team with a treating surgeon for spinal infections
  • MRI with contrast = MRI scan done with intravenous contrast is used to demonstrate areas of possible spinal infection
  • CT guided aspirate or biopsy = insertion of a needle into the spine to obtain a sample of infected fluid for laboratory culture; used in guiding antibiotic therapy