Spinal Infections (Spondylodiscitis)
Spinal infections most commonly occur in the lumbar region. It is less common in the thoracic and cervical spine. The causative agent in the spine may be of bacterial, viral, or fungal origin. These microorganisms can infect the bone, disc, or spinal nerve membrane. The causative microorganism reaches the spine through blood or direct spread from surrounding organs. Another reason is infections that develop after spine surgeries. The risk of infection increases as the microorganism finds a place to attach more easily in patients who have undergone the procedure previously and especially with metallic screws. Urinary tract or respiratory tract infections can easily spread to the spine, especially in elderly, debilitated patients. The risk of infection is higher in diabetic patients, dialysis patients, patients receiving continuous intravenous medication, AIDS patients, and cancer patients compared to the normal population. In addition, people who consume raw milk and dairy products and have contact with animals are also at risk for infections caused by Brucella bacteria.Patients often apply to the doctors with low back pain and fever. In advanced cases, neurological symptoms such as leg pain or leg weakness may occur due to the pressure caused by the infection. In the examination, the patient has tenderness in the lumbar region. Swelling, redness, and discharge may occur at the wound site in post-operative infections.
In patients with suspected infection, blood tests, (complete blood count, CRP, sedimentation rate) imaging methods (direct X-rays, CT, MRI, and scintigraphy), and culture (blood, urine, and wound cultures) are taken to reach the diagnosis. In cases where Brucella and Tuberculosis are suspected, special tests are performed for these microorganisms. In addition to urine and blood culture, culture sampling is performed by needle biopsy directly from the infection site, that is, from the spine, for diagnosis and appropriate antibiotic use in patients.
According to the results of the culture, appropriate antibiotic therapy for the causative microorganism is started. This treatment can be by oral tablets, or intravenous or intramuscular injection. What determines this is the power of the microorganism to cause infection. The duration of treatment may vary between 3 weeks and 3 months, depending on the factor.
If there is no response to antibiotic treatment, if the disease progresses, if nerve compression occurs due to infection, if there is a fracture due to damage to the spine, the infection is treated surgically. Infected tissues and bone are surgically removed. If the load-bearing properties of the spine, which we call instability, will deteriorate after this cleaning process, then it is supported with screws and metal rods to increase the carrying capacity of the spine.
Well-treated infections can cause progressive destruction of the spine, resulting in deformities that lead to humping. In this case, other surgical treatments may develop.