SURGICAL MANAGEMENT FOR INFECTIONS OF SPINE

What are spinal infections?

Our spinal cord is the most vulnerable organ and is naturally covered by dural sac and vertebral bones so that it is protected by external forces. Spinal infections though rare, they can be extremely destructive in nature at times and can lead to a number of instabilities and neurological disturbances in the body.

A spinal infection can develop as inflammation to the disc, an abscess formation within the spinal canal or a much intense form as osteomyelitis which is infection in the vertebral bodies. Infections are largely bacterial or fungal, and tuberculous. 

Common risk factors of spine infections

•          Another infection in the body which spreads through the blood stream.
•          A wound.
•          Urinary tract infection.
•          Diabetes in elder patients.
•          Immune suppression: transplant and HIV

The course of the infection is such that it restricts itself to vertebral end plates and reduces blood flow. Once the infection is established, a large portion of the vertebra gets eroded. Gradually the infection starts spreading to the lower and above vertebra one after the other.

What are the diagnostic findings for a spinal infection?

Physical test: Spasm and pain over the affected area. Neurological examination may or may not be normal. Patient may have fever above 100 degrees.

Imaging: The X-Ray shows slight changes in the vertebral edges which is evident only after 2-3 weeks of infection. MRI confirms the presence of abscess, extent of damage to spine and severity of the infection. The tuberculous infections do not affect the disc while osteomyelitis majorly destroys the disc and vertebral margins.

Laboratory tests: Most patients show elevated WBC count, and many show elevated CRP or C- reactive protein and Erythrocyte sedimentation rates. A PPD skin test rules out the possibility of tuberculosis. Lab tests should be repeated frequently to check the working of antibiotics.

Red flags: Red flags are the signs suggestive of tumor, cancer or infection like excruciating pain, chills, fever, weight loss and night sweats. These should be recognized well as symptoms of spine infection emerge slowly.

Surgical options

There is spontaneous need for orthopedic spine surgery whenever there is a localized abscess, sepsis, advanced neurological deficits and failure of biopsy and antibiotics.

Surgical drainage

It is done as an emergency procedure when there is an abscess next to spinal cord.

Spinal decompression

It is done to relieve the pressure on the spinal cord from disc or tumor.

Debridement

It is simple washing and closing the wound after removal of infected material.

Spinal fusion

The two vertebrae are fused together to prevent further perpetuation of infection and to manage the neurological deficits.

Internal fixation

It is done in patients with extensive osteomyelitis to hold the weakened vertebral bodies together. This restores the anterior column of the spine after the bone graft is injected from the hip bone. 

The spinal treatment largely depends upon the patient’s current health condition and the presence of neurological symptoms like paralysis.