Spine Infections

Spine Infections

SPINE INFECTIONS

In some cases; Infection may develop in the spinal bone structure, the cushions between the vertebrae (disc), the membrane surrounding the spinal cord (dura mater), or the space around the spinal cord. The cause of the infection may be one of several bacteria or fungi.
Spinal infections may occur after a spinal surgery or may develop spontaneously for patients with certain risk factors. Risk factors for infection can be listed as follows; malnutrition, immune system disorders, HIV infection, cancer, diabetes and obesity. In addition, individuals who consuming raw milk and dairy products also may risk to consist of brucella bacteria.

SYMPTOMS OF SPINE INFECTIONS

• Feverish
• Weakness
• Headache
• Neck stiffness
• Swelling at the surgical wound
• Sensibility
• Redness
• Purulent discharge
• Pain 

In some cases, the patient may feel finding in his/her arms and legs, loss of sensation, and weakness in muscle strength. While these findings are so insidious in some patients but they might be appear excruciatingly from the beginning for other patients.

HOW DOES SPINAL INFECTIONS OCCUR?

Epidural Abscess: The treatment method for epidural abscesses is usually surgery. The patient's neurological status and MRI findings determine the treatment. If there is a bacteriological diagnosis in fluid-containing epidural abscesses without neurological deficits, medical treatment can be applied. Surgery is required in cases that do not respond to medical treatment, do not have a bacteriological diagnosis, and whose neurological picture does not improve or deteriorates.
Tuberculosis: It settles in the lungs by droplet infection of Mycobacterium tuberculosis. It then holds the vertebral body through this segmental artery. A segmentary artery irrigates the two vertebrae. Therefore, it reaches more than a vertebra.

The pathology is located in the vertebral body rather than the posterior elements. A slowly developing necrosis in the bone; granulation tissue and caseification necrosis replace the bone. Vertebral body collapse may occur frequently. A calcified paraspinal soft tissue mass can be seen on computed tomography (CT). This condition is spinal tuberculosis; in other words, it is characteristic for Pott's disease.

At the onset of the disease, it is possible to observe the bone lesion on magnetic resonance imaging (MRI) without disc involvement. On MRI, T1-weighted images show narrowed disc space and low-signal-intensity images of adjacent spinal bone marrows. In T2-weighted series, high signal intensity is seen in the disc space and the affected vertebral bodies. It may not be easy to distinguish between pyogenic vertebral osteomyelitis and Pott's disease radiologically. In Pott's disease, the disc distance is preserved, kyphosis development and paraspinal abscess formation are more common.

Treatment of the disease may include chemotherapy and surgery. We can list the indications for surgery as follows; deformities such as neurological deficit, spinal instability, angulation and kyphosis, failure to respond to medical treatment, and failure to diagnose with biopsy.


Discitis: When there is a primary infection of the nucleus pulposus, it affects the cartilage endplate and the vertebral body secondarily. It is usually a benign and self-limiting infection. Local low back pain aggravated by movement; It can spread to the perineum, leg, and scrotum.

Endplate fragmentation, increase in paravertebral soft tissue and closure of fat planes or paravertebral abscess may be seen on CT. The white blood cell count is usually within normal limits. Staphylococcus aureus is the most common causative microorganism if direct culture can adhere.

Treatment includes immobilization and antibiotics. Antibiotics are continued for 4-6 weeks IV and for the next 4-6 weeks in the form of oral or sedimentation. It is administered in two ways, IV and then orally, until it returns to normal.

Brucellosis: It is a bacterial infection transmitted to humans by infected animal foods (raw milk and dairy products). The most common type in humans is Brucella melitensis, which has the highest virulence and invasive effect. Bone involvement is the most common complication, and the spine and sacroiliac joints are the most frequently involved sites.

Spinal brucellosis begins with a minor destruction of the superior endplate with well blood supply. Thus, it advances and holds the entire vertebral body and disc space. L4 and L5 vertebrae are mostly involved. The clinical presentation is often in the form of low back and joint pain. MRI is the most helpful method in radiological diagnosis. Endplate involvement, discitis, facet joint involvement, granulomatous tissues, epidural and soft tissue abscesses can be seen with this method. Tuberculosis is considered in the differential diagnosis.

The main treatment of Brucella spondylitis is medical. Dosages of doxycycline 200 mg/day and rifampicin 600-900 mg/day are recommended for 6-8 weeks.

Spinal Infections Treatment Methods

Non-surgical treatment method: That includes the use of antibiotics, antituberculosis treatment and antifungal treatments for fungal infection. Type and duration of treatment; It depends on the severity of the infection and the causative microorganism.

Antibiotic and antifungal drugs are given intravenously or orally. In case of intravenous drug administration; this treatment can be done in the hospital or at home with a catheter under the supervision of a healthcare professional. The duration of treatment should be as short as 7-10 days or as long as 6-12 weeks. In some cases, your doctor may apply brace therapy for control pain and rest the spine.

Surgical treatment method: Options may vary depending on the type and location of the infection, the size of the abscess, the damage it causes, and the patient's immune system. The simplest option is to drain the abscess and clean the infected tissues. Sometimes it may be necessary to use cages and instrumentation to replace destroyed vertebrae. While the wound is closed and a drain is placed after the procedure, in some cases the wound can be left open and washed periodically. Or, a way such as providing continuous drainage by applying negative pressure with pressurized tissue covers (woundvac) can be followed.