Surgical treatment for spinal infections

Spinal infections – what are they?

Spinal cord in the human body is one of the most susceptible organs at risk for injuries and traumas. It can get damage easily; hence naturally it is covered by a protective sheath called dural sac and vertebrae which provide stability to spine.

Spinal cord infection may manifest itself as discitis or disc inflammation, a pus filled abscess adjacent to spinal cord or as osteomyelitis which is a severe infection of vertebral bodies. Spinal infections are bacterial, fungal or tuberculous in nature and can be devastating resulting in many internal instabilities and neurological problems.

Predisposing factors for spinal infections

•          Diabetes
•          Liver/kidney transplants.
•          Immune suppression like AIDS
•          An unhealed wound.
•          Urinary tract infection
•          An active infection in any other part of the body which is likely to spread via blood stream.

As one begins with the spinal treatment it is important that the course of infection is identified and established. This is necessary to differentiate whether the infection is restricted to the vertebral margins or a large area of vertebra is replaced by infected material. The infection may also further spread to the vertebras placed lower and above. 

Investigations

Look for red flags:

Signs like unrelenting pain, fever, chills, weight loss and night sweats are called red flags. These signs are highly suggestive of infection or tumor growth. Since they emerge very slowly and steadily, it is a challenge for the doctor to identify them in time and begin further investigations.

Physical examination

The doctor checks for any history of fever. Furthermore, the patient is examined for pain and stiffness around the affected area and a basic neurological test for reflexes and co ordination is conducted.

Radiological tests

With X-Ray, changes in the vertebrae are generally noticed after 2 weeks of infection. MRI is more accurate in locating the size of abscess and extent of damage.

Lab examinations

There is elevated WBC, CRP and ESR. PPD skin test is done for tuberculosis.

Various types of surgeries for spine infections

Presence of neurological issues like tetraplegia or paralysis of one limb, sepsis, pus filled cavity, failure of biopsy and medications are certain important things for which the patient has to decide for orthopedic spine surgery at spur of the moment.

  

a)      Irrigation and debridement

The wound is opened and washed after infected material is removed. 

b)      Drainage

Surgical incision of pus when the abscess id within the spinal canal and compressing the spinal cord. 

c)       Decompression of spine

The disc or tumor which is causing compression to spine is removed. This is performed as an emergency procedure. 

  

d)      Spinal fixation

Metal fixation is done to stabilize two weakened vertebrae which have progressive osteomyelitis. A bone graft from hip bone is infused which further stabilizes and preserves anterior spinal column. 

e)      Spinal fusion

Two vertebrae are fixed to function like one body. This prevents further aggravation of infection and also controls neurological deficits to a certain extent.