Spinal Infection

Overview

A spinal infection is an infection that affects part of the spine. It can involve the vertebrae (the bones of the spine), the discs between them, the spinal canal, or the surrounding soft tissues. Depending on the location, it may be called vertebral osteomyelitis (infection of the bone), discitis (infection of a disc), or a spinal epidural abscess (a collection of pus in the spinal canal).

Most spinal infections are caused by bacteria that travel to the spine through the bloodstream from another site in the body, though some follow spinal surgery or a procedure. Spinal infections are relatively uncommon but serious. They tend to develop gradually, which can delay diagnosis, and if left untreated they can damage the spine and, in the case of an abscess, press on the spinal cord. Early recognition and treatment are important to prevent lasting harm.

Symptoms

Symptoms often come on slowly and can be mistaken for ordinary back problems. Common features include:

• Persistent or worsening back or neck pain, often worse at night and not relieved by rest
• Fever, chills, and night sweats
• Tenderness over the affected area of the spine
• Unintended weight loss and fatigue
• Stiffness and difficulty moving

If the infection forms an abscess that presses on the spinal cord or nerves, it can cause numbness, tingling, weakness, or, in serious cases, problems with bladder or bowel control. Severe or rapidly progressing weakness, numbness in the groin, or loss of bladder or bowel control are emergencies that need immediate care.

Causes

Spinal infections are usually caused by bacteria, and sometimes fungi, reaching the spine. Routes of infection include:

• Spread through the blood: The most common route, where bacteria from an infection elsewhere, such as the skin, urinary tract, or lungs, travel to the spine.
• After surgery or a procedure: Infection introduced during spinal surgery, injections, or other procedures.
• Direct spread: From an infection in nearby tissue.

Tuberculosis can also affect the spine in a form sometimes called Pott disease. People with weakened immune systems or other health problems are more vulnerable, and intravenous drug use is an important risk for bloodstream infections that can seed the spine.

Risk Factors

• A weakened immune system, from illness or medications
• Diabetes
• Intravenous drug use
• Recent spinal surgery, injections, or other procedures
• An ongoing infection elsewhere in the body
• Older age, poor nutrition, or long-term illness
• Cancer or organ transplant

Diagnosis

Because symptoms can be vague, diagnosis often relies on a combination of tests. These may include:

• Blood tests: Markers of inflammation and blood cultures to detect bacteria in the bloodstream
• MRI scan: The most sensitive imaging for showing infection in the bones, discs, and surrounding tissue, including abscesses
• CT scan or X-ray: To assess bone changes
• Biopsy: Taking a sample from the affected area to identify the exact organism and guide antibiotic choice

Treatment

Treatment aims to clear the infection, relieve pain, and protect the spine and nerves. It is usually managed in or coordinated with a hospital.

• Antibiotics or antifungals: The mainstay of treatment, often given intravenously at first and continued for several weeks, chosen to target the specific organism.
• Immobilization: A brace may be used to support the spine and reduce pain during healing.
• Pain management: Medicines to control pain.
• Surgery: Needed in some cases to drain an abscess, remove infected tissue, relieve pressure on the spinal cord, or stabilize the spine.

With prompt, appropriate treatment, many people recover well, though severe infections or delays in care can lead to lasting spine or nerve damage. Close follow-up ensures the infection is fully cleared.

When to See a Doctor

See a doctor promptly for back or neck pain that is severe, steadily worsening, worse at night, or not relieved by rest, especially when combined with fever, chills, unexplained weight loss, or a recent infection or spinal procedure. Seek emergency care immediately if you develop new or rapidly worsening weakness or numbness in the limbs, numbness around the groin, or loss of bladder or bowel control, as these can mean the infection is pressing on the spinal cord.

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (OrthoInfo). Spinal Infections.
2. Cleveland Clinic. Spinal Infections.
3. MedlinePlus, U.S. National Library of Medicine. Osteomyelitis.
4. American Association of Neurological Surgeons (AANS). Spinal Infections.