Spinal Infections

What are spinal infections?

Spinal infections are rare, but often very serious diseases that happen when pathogens such as bacteria, viruses, parasites, fungi or prion invade the spinal tissues through the bloodstream or peripheral nerves. 

When pathogens infect the intervertebral discs, it is known as discitis. When they infect the bones (vertebrae) of the spine, it is known as osteomyelitis, and when they infect the sacroiliac joints connecting the lower spine to the pelvis, it is called sacroiliitis. Spinal infections can be quite serious, as your vertebral bodies or bones might start to decay if they are infected, causing cracking or fracturing of bones, which eventually leads to deformities if allowed to progress.

Other issues that can develop because of spinal infections include nerve pain and the buildup of pus in the spine (abscess), which can be painful and place unnecessary pressure on your spinal cord, known as spinal stenosis.

Thus it is essential to seek urgent medical attention if you suspect that you may have a neuroinfection.

What does having a spinal infections feel like?

Although unrelenting back pain, fatigue, redness, swelling, pain and fever are characteristic of most spinal infections, they rarely present with classic signs and may mimic the symptoms of other diseases, such as influenza. You might also experience weakness or numbness if the infection has progressed a lot. Symptoms vary depending on the type of spinal infection as well. 

Symptoms of discitis include:

  • Lower back pain/back pain that does is not relieved with rest
  • Changes in posture
  • Pain when moving
  • Neck stiffness
  • Fever or chills
  • Difficulty performing daily tasks, decreased range of motion
  • Abdominal pain

Symptoms of osteomyelitis include:

  • Pain in the arms or legs
  • Fever or chills
  • Muscle spasms
  • Issues using your hands or walking

Symptoms of sacroiliitis include:

  • Pain in the lower back, hips, buttocks and thighs
  • Pain aggravated by prolonged standing or doing any physical activity
  • Pain can sometimes be in your legs, groin and feet as well

What are the causes of spinal infections?

Pathogens usually spread to the spine through the bloodstream, and common bacteria (Staph, E. Coli) can be introduced into our bodies through events such as surgery (when instruments are not properly sterilised), or drug abuse. These events can also weaken our immune system and make developing spinal infections more likely.

Infections such as urinary tract infections, pneumonia and tuberculosis can also spread from other parts of your body to the spine. People who are elderly, have other medical conditions like diabetes, or whose immune systems are otherwise compromised (e.g. recent organ transplant patients) also are more likely to get spinal infections. Trauma or injury to the spinal cord can also cause infections to develop.

How are spinal infections diagnosed?

Spinal infections are destructive and life-threatening if not treated early. Thus, early diagnosis is key. If you are currently experiencing the symptoms listed above, consult a doctor and seek medical treatment immediately. 

To determine the severity and cause of your neuroinfection, your doctor may conduct one or more of the following: 

Detailed physical and neurological examination. Your doctor will conduct a thorough medical examination before definitively diagnosing you with a spinal infection. Your doctor will likely ask about your medical history and perform tests to evaluate your vision, speech and reflexes. 

Bone scans. Your doctor may use a bone scan to examine the spaces around your vertebrae to assess your bone health. Radioactive material will be injected into a vein which will flow through your blood and collect in your bones, and this will be shown through imaging technology.

Neuroimaging (CT, MRI scans). Your doctor may also make use of neuroimaging, such as CT and MRI scans, to diagnose your spinal infection. Neuroimaging refers to the use of various techniques to image the structure, function, or pharmacology of the nervous system. Your doctor may use this to help visualise your nervous system and identify the site of inflammation, revealing any bone deterioration or changes to your spinal structure. This would allow for rapid diagnosis and subsequent treatment decisions made by your doctor. 

Blood Tests. Your doctor may carry out a few blood tests, including examining your white blood cell count, which will be abnormally high in most spinal infection cases.

If you suspect that you might have a spinal infection, please seek medical attention immediately. A spine infection is considered a medical emergency, so to avoid any serious complications, seek treatment as soon as you can.

How are spinal infections treated?

If you have discovered a spinal infection in its early stages, your infection can be managed well with the help of antibiotics, bed rest and in some cases, the use of spinal braces in the recovery process. 

Although many spinal infection cases do not need surgical treatment, around 50% of cases end up undergoing some sort of surgery in order to recover [1]. Speak to your doctor if you think you might have a spinal infection, and a prompt diagnosis can be made.

  1. Tsantes, A., Papadopoulos, D., Vrioni, G., Sioutis, S., Sapkas, G., Benzakour, A., Benzakour, T., Angelini, A., Ruggieri, P., & Mavrogenis, A. (2020). Spinal Infections: An Update. Microorganisms, 8(4), 476. https://doi.org/10.3390/microorganisms8040476
  2. Sacroiliitis; Symptoms, Causes, Management & Treatment. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17736-sacroiliitis
  3. Spinal Infections: Practice Essentials, Anatomy, Pathophysiology. (2020). EMedicine. https://emedicine.medscape.com/article/1266702-overview
  4. Spinal Infections Symptoms & Treatments. (n.d.). The Advanced Spine Center. Retrieved December 14, 2020, from https://www.theadvancedspinecenter.com/conditions/spinal-infections/
  5. Stanford Healthcare. (n.d.). Stanfordhealthcare.org. Retrieved December 14, 2020, from https://stanfordhealthcare.org/medical-conditions/back-neck-and-spine/spinal-infection/risk-factors.html
  6. Thoracolumbar Spine Infections. (n.d.). USC Spine Center – Los Angeles. Retrieved December 14, 2020, from https://www.uscspine.com/conditions-treated/back-disorders/thoracolumbar-spine-infections/
  7. UpToDate. (n.d.). Up To Date. https://www.uptodate.com/contents/vertebral-osteomyelitis-and-discitis-in-adults