Spinal Infections

What are spinal infections?

Spinal infections are categorised according to the anatomical location (intervertebral disc space, spinal canal, vertebral column, and surrounding soft tissue) in which they are involved, as well as the pathogen (bacteria or fungus).

What are frequently occurring spinal infections?

• Vertebral osteomyelitis is a highly common vertebral infection that can arise from direct spinal trauma, infections in nearby regions, and bacteria that travel to the vertebrae from the blood.
• A spinal epidural abscess occurs when an infection arises in the area surrounding the dura. An epidural abscess can lead to prolonged back pain, weakness or complete paralysis of the legs, loss of bowel and bladder function, high fever and other accompanying symptoms. Usually, a magnetic resonance imaging (MRI) scan is ordered to check for epidural abscess; if an MRI is not feasible, myelography and computed tomography are used to identify this infection.

How do you treat a spinal epidural abscess?

Treatment for a spinal epidural abscess includes antibiotics and, in severe cases, when the abscess increases pressure and puts further strain on the spinal cord, immediate drainage. Immediate treatment significantly reduces complications compared to when the abscess is left undiagnosed and untreated. Surgical drainage, together with antimicrobial therapy, is a widely performed treatment for a spinal epidural abscess.

A midline incision is made over the back and the lamina (the back part of the vertebra) is removed to gain access to the epidural space. Multiple levels may need to be operated to gain adequate access. The abscess is drained and washed out. The wound is then closed in layers.

Initiating treatment for a spinal epidural abscess promptly is crucial. Delays in diagnosis and treatment can lead to irreversible neurological damage. Some patients may require immediate hospitalisation, depending on the extent or severity of the infection. A fluid sample from the abscess is drained and sent to the laboratory for a detailed analysis, underscoring the importance of early intervention in preventing complications.