What are spine infections?
Infection can settle in the disc space (discitis), in the vertebral bone (osteomyelitis), or in the space surrounding the spinal cord (epidural abscess). It usually arrives through the bloodstream from elsewhere in the body, and occasionally follows a procedure. It is uncommon, but because it can damage bone and compress neural structures, it is assessed quickly once suspected.
Symptoms
- Back or neck pain that is constant and does not ease with rest or position
- Pain that is worse at night, often waking you
- Fever, chills, night sweats, or unexplained weight loss
- Localized tenderness over one area of the spine
- New weakness, numbness, or difficulty walking if the cord or nerves are involved
Urgent
Seek urgent medical care for back pain with fever, or for new weakness, numbness, or any change in bowel or bladder control. Epidural abscess is a neurological emergency and is treated on the same day.
Who is at higher risk
Risk is higher with diabetes, immune suppression, injecting drug use, recent bloodstream infection, dialysis, or previous spinal surgery. None of these is required for an infection to occur, but together they raise the index of suspicion when pain has the features above.
How it is diagnosed
Blood tests, inflammatory markers and cultures, are central, alongside MRI with contrast, which shows the extent of involvement and whether an abscess is present. A biopsy is frequently performed to identify the organizm, because targeted antibiotic therapy depends on knowing what is being treated.
Treatment
Most infections are treated with a prolonged course of targeted antibiotics, often several weeks, with monitoring of inflammatory markers and repeat imaging. Bracing may be used for comfort and stability. Surgery is indicated when there is neurological compression, significant instability or deformity, or an abscess that does not respond to medical treatment, and in those cases it is not delayed.