Lumbar Spinal Infection
Spinal infections can be classified by the location involved whether it's the verterbral column, intervertebral disc space, the spinal canal, or the adjacent soft tissues. Infection may be caused by bacteria or fungal organisms and may occur after surgery or spontaneously in patients with certain prevalent risk factors. Most postoperative infections occur between three days and three months after surgery.
Causes & Risk Factors
Risk factors for spontaneous infections include poor nutrition, intravenous drug use, human immunodeficiency virus (HIV), cancer, diabetes, obesity, organ transplant patients, malnutrition, long term use of steroids as well as advanced age.
Surgical risk factors include operations of long duration, high blood loss, instrumentation and multiple operations at the same site. Infections occur in 1 to 4 percent of surgical cases, despite numerous preventative measures that are adhered to. The veins in the lower spine (Batson's plexus) drain the pelvis and provide for a direct route of entry for the bacteria to get into the spine. Because of this, there is a higher rate of infections in that area of the spine that occur after a urologic procedure.
Symptoms of a spinal infection will vary depending on the type and location of the spinal infection however they may include:
- Severe back pain
- Local tenderness in the spinal column
- Weight loss
- Muscle spasms
- Painful or difficult urination
- Neurological deficits
- Pain that is worse in the nighttime than in the daytime
Spinal Canal infections in adults often progress through the following stages:
- Severe back pain with fever and local tenderness in the area
- Nerve root pain radiating from the infected area
- Weakness of voluntary muscles and bowel/bladder dysfunction
- Possible paralysis
In addition, postoperative infections may include the following symptoms:
- Wound redness & tenderness (if from surgery)
- Wound drainage (if from surgery)
Diagnosis of a spinal infection may take a month or as long as six months depending on the type of infection and location. Unfortunately many patients do not seek medical attention until their symptoms are severe or debilitating. A combination of lab tests, x-rays, MRIs, and CT scans may be needed in order to identify the location and extent of the infection. Cultures may also be necessary in order to determine the type of bacteria or fungus causing the infection.
Both nonsurgical and surgical treatments are available and our experts at SCCNS will evaluate every option available and educate our patient on every aspect of treatment.
The nonsurgical treatment of spinal infections often require long-term use of an intravenous antibiotic or antifungal therapy and can result in the hospitalization for as little as 7-10 days or as long as 8-12 weeks. A back brace may also be used to alleviate pain and to keep the spine stable.
Nonsurgical treatments are the first option when patients have minimal or no neurological deficits. However surgery may be necessary if a patient does not respond to antibiotic or antifungal therapy and their condition is worsening. For postoperative infections a simple surgery to wash away the bacteria may suffice or it may be necessary to perform a more extensive debridement and removal of infected tissues. In addition, in some cases, surgery may be required when there is evidence of spine instability or severe weakness as a result of the infection.
If surgery is necessary, your expert at SCCNS will discuss in detail the necessary procedure so that you are able to make an informed decision about your treatment.