Acıbadem Comprehensive Spine Center

Spinal Infections

In some cases, infection may develop inside the spinal bone structure, the intervertebral disks, the membrane surrounding the spinal cord (dura mater) or the space around the spinal cord. Infection may be caused by various bacteria, viruses or fungi. 

Spinal infections may occur following a spinal operation or may develop spontaneously in patients with certain risk factors. Risk factors for infection may include malnutrition, immunity system disorders, HIV infection, cancer, diabetes and obesity. Also individuals who consume raw milk and dairy products are under risk of infections caused by brucella bacteria. 

Surgical risk factors include extended periods of surgery, use of instrumentation and revision surgery. In spite of various measures taken, even in hospitals offering the best conditions infection rate may increase up to 4%, especially due to use of instrumentation. Repeated surgeries on the same area may further increase the risk. Majority of postoperative infections arise on the third day after surgery and after three months.   

What are the symptoms of spinal infections?

Infection symptoms include fever, malaise, headache, hard neck, swelling, sensitivity, redness, discharge and ache in the surgery scar. In some cases the patient may feel symptoms such as numbness in arms and legs, loss of sensation, weakened muscle power. These symptoms may be very subtle in some patients and very powerful right from the beginning in others. 

How to diagnose spinal infections?

Diagnosis starts by collecting patient’s history and examining the patient. Your doctor will ask you questions in order to diagnose spinal infection. He will ask you to have some tests done if he has doubts about infection. Among these tests are several blood tests (full blood analysis, CRP, sedimentation speed) and monitoring methods (direct radiography, BT, MR and scintigraphy).

These blood tests may give slightly high post operative results even without infection and but usually return to normal in a few weeks. In a later post operative period or in patients without surgery, significantly high test results may indicate infection. 

Among other laboratory tests that you may be asked to have done are blood cultures that definitely prove the existence of an infection and give an idea about the type of microorganism that caused the infection and tissue samples that are obtained by biopsy from the infected zone or defluxion cultures obtained from the scar. Biopsy is generally performed using local anaesthesia and fluoroscopy (monitoring device).

Other than the above, serological blood tests may be done for brucella infection that is frequently encountered in our country, and PCR and skin sensitivity test (PPD) for tuberculosis.

Nonsurgical treatment of spinal infection

Nonsurgical treatment includes the use of antibiotics, antituberculosis treatment, antiviral treatments for some viral infections and antifungal treatment for fungal infection. The type and period of treatment varies with the severity of infection and the causing microorganism.

Antibiotics and antifungal medicine are administered intravenous or orally. In case of intravenous administration, treatment can be done in hospital or as outpatient with the help of a catheter or at home under the supervision of a health care officer. Treatment may last as short as 7-10 days or as long as 6-12 weeks. In some cases, the physician may prescribe corset treatment in order to control the pain and to help the spine relax. 

When is surgical treatment needed?

Surgery may be needed for patients with abscess that will not respond to antibiotics treatment, in cases of abnormal movement because of vertebral bruises, development of deformities (vertebral shifts, sclerosis, kyphosis) and associated severe pain. In addition, urgent surgical operation is needed for patients with abscess or spinal fractures or spinal cord compression due to kyphosis or associated damage in nerves (loss of power, severe numbness). For these patients surgery is needed to remove the compression on the spinal cord. 

What are the surgical options?

There are several options. They vary depending on the type and location of infection, the size of abscess, the resulting damage and the patient’s immunity system. In some cases, discharge of abscess and cleaning of infected tissues (debridement) may be sufficient, whereas in others the use cradles and instruments may be needed to replace damaged vertebras. Following the operation, sometimes the scar is covered after placing a drain inside and sometimes the scar is left open for periodical washes or continuous drainage may be provided by applying negative pressures through pressurised tissue covers (woundvac). 

When is the treatment ended?

Treatment may last long especially in cases of severe and wider infections. After the surgical operation in hospital, intravenous or oral antibiotic treatment continues for a long time. Your physician will periodically check white blood cell count, sedimentation and CRP values and end the treatment when clinical symptoms disappear and blood results return to normal.

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