Infections of The Spine: Symptoms, Risks, Diagnosis

Anyone from young children, adults, and the elderly can get a spinal infection. Individuals can have an infection:

• In vertebral bone tissue
• An intervertebral disc
• The spinal canal – space where the spinal cord runs through
• The spinal cord’s protective lining

These types of infections can happen anywhere along the spine, from the atlas at the base of the neck to the coccyx all the way to the lowest part of the back. Individuals should expect unpredictability if dealing with a spinal infection. During testing, lab results could be misleading or inaccurate. What can happen is white blood cell counts are normal, X-rays might not show any abnormalities, and sensitive diagnostic tests like a CT or MRI scan might not show positivity of infection for a week or more. What to know about spinal infections.

Spinal Infection Types

They are classified according to the type of tissue they infect. The most common include:

Vertebral Osteomyelitis

This is a common infection type. Bacteria most often cause the cause. It can develop after trauma to the spine, post-surgery, or bacterial infections located in other body parts that travel via the blood to the vertebra. Symptoms include:

• Persistent, chronic back pain that can become severe worsens at night and becomes aggravated from moving.
• The pain radiates/spreads into the arms and legs
• Tingling, numbness, and burning sensations
• Inflammation
• Fever
• Weight loss
• Vomiting
• Post-surgery wound drainage, redness, and swelling near the surgical site

Treatment includes:

• Intravenous antibiotics
• Antibiotics
• Over-the-counter analgesics like nonsteroidal anti-inflammatory meds for pain relief.
• Prescription pain medications
• Back brace
• Surgery is recommended if antibiotic treatment fails, nerve damage develops, a spinal deformity develops, or to remove infected bone and/or soft tissues.

Discitis

This type of infection develops between the intervertebral discs. It is also rare, but it is more common in children and adolescents, but it can still happen in adults. Discitis can be potentially deadly, despite advanced treatment. The most common causes are bacterial and viral infections.

• The Staphylococcus aureus bacterium, known as staph, is the most common microbe that can cause discitis.
• Other forms of staph that cause discitis include:
• E. coli
• Salmonella
• Strep
• Fungi
• Autoimmune disorders

Symptoms
Individuals with discitis can present with minimal symptoms when the infection initializes, but it does worsen and can cause:

• Abdominal pain and discomfort
• Posture changes
• Mobility issues
• Difficulty performing everyday tasks
• Fever
• Severe back pain that worsens at night or by moving

Treatment options include:

• Antibiotics
• Anti-inflammatory medications
• Supportive devices
• Rest
• Steroids to alleviate inflammation in chronic and severe cases
• Severe cases could require surgery to restructure areas of the affected spine to improve function and mobility

Epidural Abscess

This is an infection that can develop in the spaces between the bones of the spine, the skull, or soft tissues surrounding the brain and spinal cord. This is a medical emergency that needs to be addressed immediately. The infection is often caused by a bacterial or fungal infection in or around the affected area. This is commonly a Staphylococcus aureus bacteria. In some cases, an abscess can develop from an infection in another part of the body. This could be a urinary tract infection that spreads out to the spine. Symptoms include:

• Inflammation and swelling
• Mid to low back pain
• Headache
• Fever
• Nausea and/or vomiting
• Neurological weakness, numbness in the arms and legs, bowel or bladder incontinence
• Walking problems

Treatment consists of intravenous antibiotics to combat the infection that caused the abscess. In some cases, if there is difficulty moving around or are experiencing numbness, then surgery is required to drain the abscess or completely remove it.

Risk Factors

Spine infections can affect anyone. However, there are individuals with certain chronic health problems that have an increased risk. They include those with:

• Kidney disease
• Liver disease
• Auto-immune diseases
• Immune systems compromised like cancer and HIV
• Individuals that have undergone a spinal surgical procedure are at greater risk post-surgery

Risk factors include:

• Individuals that have had a spinal infection could be more susceptible to developing another.
• Age – older adults
• Malnutrition
• Diabetes mellitus
• Obesity
• Smoking
• Intravenous drug use
• Certain areas of the back are more prone to infection. This includes the cervical/back of the neck and the lumbar/low back.

Surgical risk factors:

• Long surgical procedure
• Massive loss of blood
• Multiple surgeries of the same area

Diagnosis

Early diagnosis can be the difference in treating the infection before damage to the spine develops or before the damage worsens. They are diagnosed through a variety of lab and imaging tests. These include:

• Various lab tests
• Blood work to examine white blood cell counts and markers for inflammation
• X-Rays
• CT scan
• MRI

Outcome

These infections are rare, but they are serious and early treatment is recommended for optimal outcomes. Early diagnosis in the early stages can be successfully treated with antibiotics, rest, and spinal braces. Doctors, spine specialists, chiropractors, and physical therapists will work with the individual to provide a thorough diagnosis, personalized treatment plan, and long-term outcomes.

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Body Composition

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Practice Mindfulness

Practicing mindfulness can help identify stress triggers of negative thoughts and behavior. Mindfulness is unique to each individual. Sitting quietly and meditating for 20 minutes is not for everyone. Instead, try a five-minute guided meditation, writing, or music listening. The best time to meditate is in the morning after waking up. This helps set the day’s objectives, what’s important and what can wait in a clear fashion. Mindfulness practice has been shown to reduce stress and feelings of anxiety.

Journaling is a great way to find out about yourself. It can be done with pencil/pen and paper, on a computer, tablet, or phone. Take a few minutes to write some ideas, feelings, emotions that can help put things in perspective. Examples could be, writing something that makes you happy/proud, something that you want to improve, and a goal. There is also mindful listening that can help reduce stress by focusing attention. Instead of turning on the news or checking email first thing, listen to a favorite podcast or music. The same applies to over-phone use. During some downtime instead of scrolling through social media, etc, take a breath and listen to your mind and self.

References

American Association of Neurological Surgeons. Spinal Infections. www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Spinal%20Infections.aspx. Published May 2016. Accessed December 29, 2016.

Stat Pearls. (2021). Diskitis. www.ncbi.nlm.nih.gov/books/NBK541047/

Stat Pearls. (2021). Spinal Epidural Abscess. www.ncbi.nlm.nih.gov/books/NBK441890/

Frontiers in Medicine. (2014). Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. www.frontiersin.org/articles/10.3389/fmed.2014.00007/full

Microorganisms. (2020). Spinal Infections: An Update. www.ncbi.nlm.nih.gov/pmc/articles/PMC7232330/

The Spine Journal. (2021.) “Long term quality of life outcome after spondylodiscitis treatment.” www.thespinejournalonline.com/article/S1529-9430(21)00783-X/fulltext