In some cases, infection may develop within the spinal bone structure, the cushions between the vertebrae (disc), the membrane surrounding the spinal cord (dura mater), or the space around the spinal cord. The cause of the infection may be one of several bacteria or fungi. Spinal infections may occur after a spinal surgery or may develop spontaneously in patients with certain risk factors. Risk factors for infection include malnutrition, immune system disorders, HIV infection, cancer, diabetes, and obesity. In addition, our citizens who consume raw milk and dairy products in our country are also at risk for infections caused by brucella bacteria.
Symptoms of Spinal Infections
Fever Fatigue Headache Neck stiffness Swelling at the operation wound Tenderness Redness Discharge Pain may occur.
In some cases, the patient may feel numbness in his arms and legs, loss of sensation, and weakness in muscle strength. While these findings are very insidious in some patients, they appear severe from the very beginning in some patients.
Occurrence of Spinal Infections
Epidural Abscess: The traditional treatments for epidural abscesses have been surgery. The patient’s neurological status and MRI findings are the determining factors in the treatment. The collections that are hyperintense on T2-weighted sections, do not retain contrast material in the center, and have contrast enhancement in the periphery, have a liquid consistency and can be easily emptied. If there is a bacteriological diagnosis, medical treatment can be applied in fluid-containing epidural abscesses without neurological deficits. Surgical intervention is required in cases that do not respond to medical treatment, do not have a bacteriological diagnosis, or whose neurological picture does not improve or deteriorates.
Tuberculosis: After Mycobacterium tuberculosis settles in the lungs by droplet infection, it covers the vertebral corpus by hematogenous way from this focus by a segmental artery wound. Because a segmental artery irrigates the two vertebrae, it involves more than one segment.
Pathology localizes to the vertebral body rather than posterior elements. A slowly developing necrosis in the bone, caseification necrosis replaces the bone with granulation tissue. Vertebral body collapse is common. The presence of a calcified paraspinal soft tissue mass on computed tomography (CT) is characteristic for spinal tuberculosis, in other words Pott’s disease.
At the onset of the disease, it is possible to observe the bone lesion on magnetic resonance imaging (MRI) without disc involvement. On MRI, T1-weighted images show narrowed disc space and low-signal-intensity images of adjacent spinal bone marrows. In T2-weighted series, high signal intensity is seen in the disc space and the affected vertebral bodies. It may not be easy to distinguish radiologically from pyogenic vertebral osteomyelitis and Pott’s disease. In Pott’s disease, the disc distance is preserved, kyphosis development and paraspinal abscess formation are more common.
Chemotherapy and surgery have a place in the treatment of the disease. Indications for surgery are neurological deficit, spinal instability, deformities such as angulation and kyphosis, failure to respond to medical treatment, and failure to diagnose with biopsy. Antituberculosis chemotherapy includes the combination of Isoniazid, Ethambutol, Rifampicin. The treatment should be done for at least 6 months for a year and longer if necessary.
Discitis: It is the primary infection of the nucleus pulposus and it affects the cartilage endplate and vertebral body secondarily. It is a self-limiting infection that usually has a benign course. Local low back pain exacerbated by movement may spread to the perineum, leg, and scrotum.
Endplate fragmentation, paravertebral soft tissue enlargement and closure of fat planes or paravertebral abscess may appear on CT. The white blood cell count is usually within normal limits. Staphylococcus aureus is the most common causative microorganism if direct culture can adhere.
Treatment includes immobilization and use of antibiotics. Antibiotics are administered IV for 4-6 weeks and orally for the next 4-6 weeks, or IV until sedimentation returns to normal, then orally.
Brucellosis: It is a bacterial infection transmitted to humans by infected animal foods (milk and dairy products). Bone involvement is the most common complication, with the spine and sacroiliac joints being the most common sites.
Spinal brucellosis begins with a small destruction from the superior endplate with good blood supply and progresses to involve the entire vertebral body and disc space. L4 and L5 vertebrae are mostly involved. The clinical presentation is often in the form of low back and joint pain. MRI is the most helpful method in radiological diagnosis and endplate involvement, discitis, facet joint involvement, granulomatous tissues, epidural and soft tissue abscesses can be seen. Tuberculosis is considered in the differential diagnosis.
The main treatment of Brucella spondylitis is medical. Dosages of doxycycline 200 mg/day and rifampicin 600-900 mg/day are recommended for 6-8 weeks.
Spinal Infections Treatment Methods
Non-surgical treatment method: It includes the use of antibiotics, antituberculosis treatment and antifungal treatments for fungal infection. The type and duration of treatment depend on the severity of the infection and the causative microorganism.
Antibiotic and antifungal drugs are given intravenously or orally. In the case of intravenous drug administration, this treatment can be done in the hospital or with the help of a catheter to be inserted, outpatient or at home under the supervision of a healthcare professional. The duration of treatment can be as short as 7-10 days or as long as 6-12 weeks. In some cases, your doctor may prescribe brace therapy to control pain and rest the spine.
The surgical treatment method: There are several options. Options may vary depending on the type and location of the infection, the size of the abscess, the damage it causes, and the patient’s immune system. While the simplest is evacuation of the abscess and cleaning (debridement) of infected tissues, sometimes it may be necessary to use cages and instrumentation to replace the destroyed vertebrae. After the procedure, sometimes the wound is closed and a drain is placed, sometimes the wound is left open and washed periodically, or a method such as providing continuous drainage by applying negative pressure with pressurized tissue covers (woundvac).
