Spinal Infections

Infections of the spine can destroy the vertebral body, disc and also the nerves leading to spinal instability, neurologic damage including paraplegia, and death if timely treatment is not given.
Vertebral osteomyelitis  – Infections involving the vertebrae
Discitis
– Infection involving the disc
Epidural abscess – Infection in the form of pus in the spinal canal
Patients can have only one or two of these clinical entities or sometimes, all three of these entities.

Cause
Infections of the spine can be caused by

• Tuberculosis
• Bacterial infection,
• Fungus

In India, Spinal Tuberculosis/Potts Spine/Tubercular Vertebral Osteitis is the commonest form of infection and occurs most commonly in the region of the thoracolumbar spine. The infection is usually present in the other parts of the body like the lings, urine etc which usually spreads to the spine via blood stream. Once seeded the infection increases and starts to destroy the bone & disc and starts to compress the spinal cord and nerves.

Symptoms
Pain is the most prominent symptom
Neurological symptoms like weakness, numbness bladder/ bowel disturbance and also spasticity
Constitutional symptoms like fever, fatigue, loss of appetite, chills, malaise etc

Investigations
MRI and CT Scan – Contrast study. It will show the extent of damage which the infection had done.
CBS, ESR and CRP will also give crucial information.

Treatment
FNAC/Biopsy & Medical Management : Localised collection of pus without spinal instability or neurological compression. Once the pus is aspirated, investigation is done to identify whether it is bacterial or tubercular and appropriate medication is given.

Surgery: If there is spinal instability or neurological compression, then spinal stabilisation surgery is mandatory. The pus is evacuated, spine is decompressed and spine is stabilised with pedicle screws and rods.