Spinal Infection

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What is a spinal infection?

A spinal infection is a bacterial or fungal infection in your spine. The infection may have started in another part of your body and been carried to your spine through the bloodstream or it may have started in your spine in the days or months after surgery. Spine infections can have serious consequences and require prompt, effective treatment. 

We tend to classify spinal infection based on where they happen in your spine. Common locations include:

• The vertebral column, prone to an infection known as vertebral osteomyelitis
• The intervertebral disc space, prone to an infection known as discitis
• The spinal canal, where an epidural abscess may form
• Nearby soft tissues.

The organisms that cause infection vary from common bacteria to rare fungal infections and the return of an old adversary named tuberculosis (TB). However, the most common sources of spinal infections are two bacteria named Staphylococcus aureus and Escherichia coli.

What are the symptoms of a spinal infection?

Spinal infections may start slowly with a number of symptoms that could be put down to many other causes. Symptoms also vary considerably between patients. Some people experience no early symptoms at all and aren’t aware of the infection until it reaches an advanced stage.

Symptoms may include:

• Tenderness in your neck or back
• Pain that worsens with movement
• Stiffness in your neck
• Fever and chills
• Swelling or redness
• Unexplained weight loss
• Back pain that becomes severe and limits your mobility.

Seek urgent medical attention if you develop bladder or bowel incontinence or weakness, numbness or tingling in your arms and legs.

Who is at risk of a spinal infection?

You’re more at risk of developing a spinal infection if you are elderly, have an underlying medical condition that compromises your immune system or if you’ve had a lengthy surgery.

Conditions or lifestyle factors that compromise the immune system include:

• Intravenous drug use
• Human immunodeficiency virus (HIV) infection
• Long-term systemic usage of steroids
• Diabetes mellitus
• Organ transplantation
• Malnutrition
• Cancer.

Surgery is also a risk factor for a spinal infection. Though we take many precautions to prevent infections, they still occur in 1-4% of patients, especially if:

• The surgery has taken a long time.
• The patient has lost a lot of blood
• Implants have been used
• You’ve had several operations at the same site.

How is a spinal infection diagnosed?

Spinal infections are notoriously difficult to diagnose and are therefore often missed in the early stage.

Your doctor should take a careful history, perform a physical exam and order appropriate diagnostic investigations to determine the extent of infection and identify the organism causing it.

How do you treat a spinal infection?

Treatment aims to eradicate the infection, preserve or restore neurological (nerve-related) function, maintain spinal stability and control pain.

Non-surgical treatments for a spinal infection may require an extended hospital stay involving:

• Long-term intravenous antibiotic or antifungal therapy for at least 6-8 weeks
• Immobilisation if you’re in significant pain or your spine is unstable.

Who needs surgery?

Surgery may be recommended to drain an abscess putting pressure on the nerves in the canal (epidural abscess) or if the infection compromises the stability of your spine.

An unchecked infection can destroy spinal bone, ligaments and discs. It can also compromise your spine’s stability, creating a risk of deformity, fracture and dislocation of the spine. That can lead to neurological injury to the spinal cord or nerve roots contained within the spine. The extent of damage done by the infection can be evaluated by clinical examination supplemented with X-ray, CT, and MRI.

If your spine is unstable (or at risk of becoming so), your surgeon may operate to drain the infection and reconstruct and stabilise your spinal column. Tissue specimens will be sent for microbiological examination to identify which fungus or bacteria is behind the infection so that the right antibiotic or antimicrobial treatment can start.

Post-operative infection

Sometimes infection of the spine occurs after surgery or other procedures on the spine. If there are implants then it is often necessary to wash out the wound and gain specimens for culture. Antibiotic therapy can be directed specifically at any organisms grown from cultures but may need to be prolonged to suppress the infection. In certain circumstances implants are removed if they are no longer required for spinal stability.

How can the Victorian Orthopaedic Spine Service help?

Our surgeon, Dr David Edis, is an experienced orthopaedic surgeon who has helped many patients recover from spinal infections in his 20 years of practice. He regularly participates in the spinal on-call roster for Mulgrave Private and Peninsula Private hospitals.

If you have symptoms of a spinal infection, your first step is to see your doctor or go to your nearest emergency department for an urgent assessment. They can refer you on to our service.

Disclaimer: All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.