Infections of the Spine

Learn about the most common spinal infections, spinal infection symptoms and risk factors, and diagnosing and treating spinal infections.

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You can expect a spinal infection to affect your spine, but that’s about the only way they’re predictable. Anyone from young children to the elderly can get a spinal infection. You can have a spinal infection in vertebral bone tissue, an intervertebral disc, the space through which the spinal cord runs (the spinal canal), even the spinal cord’s protective lining. And, a spinal infection can happen anywhere along your spine, from the atlas at the base of the neck to the coccyx way down below the lower back.

As if that weren’t enough: lab results may be misleading, as normal white blood cell counts are common, X-rays often show no abnormalities early on, and even more sensitive diagnostic tests like a CT or MRI scan may not become positive for a week.

So, you can expect unpredictability if you’re dealing with a spinal infection, but there is still plenty of knowledge that can help. Here’s what you need to know about spinal infections.

Illustration of infection around the human bodyDespite treatment advances, an estimated 20 percent of people who have spinal infection die from it.As if that weren’t enough: lab results may be misleading, as normal white blood cell counts are common, X-rays often show no abnormalities early on, and even more sensitive diagnostic tests like a CT or MRI scan may not become positive for a week.

So, you can expect unpredictability if you’re dealing with a spinal infection, but there is still plenty of knowledge that can help. Here’s what you need to know about spinal infections.

Types of Spinal Infections

Spinal infections are classified according to what type of tissue they infect. The most common types of spinal infections include:

Vertebral osteomyelitis

Although vertebral osteomyelitis is the most common form of spinal infection, it is still pretty rare, accounting for only 3-5 percent of all osteomyelitis cases per year.

Causes

Vertebral osteomyelitis is most often caused by bacteria. The infection may develop after trauma to the spine, post-surgery, or from bacterial infections in other parts of the body that spread to the vertebra from the blood.

Symptoms

Vertebral osteomyelitis symptoms include:

  • Severe and persistent back pain that worsens at night and/or is aggravated by movement
  • Pain that radiates into the arms and legs
  • Tingling, numbness, and/or burning sensations
  • Inflammation
  • Fever
  • Unexplained weight loss
  • Vomiting
  • Wound drainage and/or redness and swelling near the surgical site

Treatment

Treatments for vertebral osteomyelitis include:

  • IV antibiotics
  • Oral antibiotics
  • Over-the-counter analgesics such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) for pain relief.
  • Prescription pain medications
  • Back brace

Surgery be recommended if antibiotic treatment fails, if you have developed nerve damage or a spinal deformity, or to remove infected bone or soft tissues.

Discitis

Discitis is a type of spinal infection that develops between intervertebral discs of the spine. Relatively uncommon, only one out of every 100,000 people in the U.S. will develop discitis. It is more common in children and adolescents, but can still occur in adults. Despite treatment advances, discitis remains potentially deadly. A 2015 study, also published in The Spine Journal, found a 20% mortality rate within the first year of hospital admission for a discitis infection.  

Causes

Bacterial and viral infections are the most common causes of discitis. The Staphylococcus aureus bacterium (known colloquially as staph) is the most common microbe to cause discitis, but other forms of staph, E. coli, Salmonella, strep, fungi, and autoimmune disorders can also cause it.

Symptoms

Many people with discitis may have minimal symptoms at the start of the infection but as it worsens, the infection can cause:

  • Abdominal pain and discomfort
  • Changes in posture
  • Difficulty with mobility and performing day-to-day tasks
  • Fever
  • Intense back pain worsened at night or with movement

Treatment

Treatment options for discitis include:

  • Antibiotics
  • Anti-inflammatory medications for pain relief
  • Back brace or other supportive device
  • Bed rest
  • Steroids to relieve inflammation in chronic or severe cases

In severe cases, surgery may be required to reconstruct the spine to improve function and mobility. 

Epidural abscess

​​An epidural abscess is an infection that can occur in the spaces between the bones of your spine, bones of the skull, or soft tissues surrounding the brain and spinal cord. It is often found in conjunction with a vertebral osteomyelitis or discitis infection—up to 18% of the time. An epidural abscess is a medical emergency, with an estimated mortality rate of 5 to 16%. Less than 50% of patients make a full recovery.

Causes

Epidural abscess is most often caused by a bacterial or fungal infection in the affected area, most commonly a Staphylococcus aureus bacterial infection. In some cases, epidural abscess can be caused by infections in other parts of the body (e.g., urinary tract infection) spreading through the blood to the spine.

Symptoms

Symptoms of epidural abscess include:

  • Fever
  • Inflammation and swelling
  • Headache
  • Mid to low back pain
  • Nausea and/or vomiting
  • Neurological deficits (e.g., weakness and/or numbness in the arms and legs, incontinence of the bowel or bladder)
  • Trouble walking

Treatment

In most cases, intravenous antibiotics are used to treat the infection that caused the epidural abscess. In some cases — if you have difficulty with movement or are experiencing numbness — surgery is required to either drain the abscess or remove it entirely.

Other

Other types of spinal infections include:

  • Spinal subdural empyema. Rare infection that may cause rapid compression of the spinal cord or brain. Often caused by the spread of infection in another part of the body or osteomyelitis.
  • Meningitis. Inflammation of the protective membranes that cover the brain and spinal cord. Most often caused by a bacterial or viral infection in the fluid surrounding the brain and spinal cord; may also be caused by injury, cancer, certain drugs, and other types of infections that spread to the area.

Spinal Infection Risk Factors

Spinal infections of all types are commonly caused by either a bacterial or fungal infection. “Well over half of all spinal infections are caused by either staphylococcus or streptococcus bacteria,” says Iowa-based ​​orthopedic surgeon & sports medicine specialist Benjamin Bjerke, MD, MS.

Spine infections can affect anyone, from young children to the elderly. People who have certain chronic health problems are particularly susceptible.

“Those who have additional health problems are at greater risk and include those with kidney disease, liver disease, auto-immune diseases and those with immune systems that are compromised such as those with cancer and HIV,” says Rahul Shah, MD, board certified orthopedic spine & neck surgeon at Premier Orthopedic Associates with locations around southern New Jersey. “In addition, if one has had a surgical procedure on the spine, the risks of infections are greater in the postoperative period.”

 “Other times,” says Dr. Bjerke, “the infection may exist elsewhere in a person’s body and travel through the bloodstream to the spine.”

Risk factors for developing spinal infection include:

  • Advanced age
  • Autoimmune conditions
  • Cancer
  • Diabetes mellitus
  • Intravenous drug use
  • Malnutrition
  • Obesity
  • Smoking

“Some risk factors are specific to the patient, and others are specific to the type of operation,” says Dr. Bjerke. “Certain areas of the body are more prone to infection, such as the cervical area (back of neck), followed by the back of the lumbar spine.”

Sterile surgical tools to avoid a spinal infectionSpine surgery is a risk factor for spinal infections.

Surgical risk factors that increase the risk of developing a spinal infection include:

  • Long duration of surgical procedure
  • High blood loss
  • Multiple surgeries at the same site

Infections occur in approximately 1-4% of surgical cases, though preventative measures are carefully followed to reduce the risk of infection. “If you have had a spinal infection in the past, you may be more susceptible to developing another,” says Dr. Bjerke.

Spinal Infection Diagnosis

Early diagnosis of spinal infections is important so the infection can be treated before damage to the spine occurs or before damage worsens. Spinal infections are diagnosed through a combination of lab work and imaging tests, including:

  • Lab tests. Blood work may be required to examine white blood cell counts and markers for inflammation (e.g., erythrocyte sedimentation rate).
  • X-Ray
  • Computed tomography scan (CT scan)
  • Magnetic resonance imaging

Spinal Infection Treatment

Early treatment for spine infections is key in order to reduce the risk of permanent damage to your spine and neck. Treatments vary depending on the type of infection, but most spine infections treatment options include:

  • Intravenous (IV) antibiotics. A first line of treatment, these may be prescribed anywhere from 10 days to 8 weeks.
  • Oral antibiotics. Depending on the severity of the infection, a course of oral antibiotics may be prescribed for weeks or months, following IV antibiotics.
  • Bracing. Back and cervical braces provide stability while the spine heals.
  • Rest. Back pain due to infection often worsens when mobile, so many doctors suggest resting until the infection is cleared.

In some cases, surgery may be required to treat and remove the infection if antibiotics were not effective. Surgical treatment is also used to repair any damage to the spine, restore function and mobility, and prevent further damage from occurring.

Spinal Infections and You

Though relatively rare, spinal infections are serious and must be treated early for optimal outcomes. Most spinal infections diagnosed in the early stages can be successfully treated with antibiotics, bed rest, and spinal braces.

In serious cases with severe symptoms or damage to the spine, surgical treatment may be required. If you suspect you have a spinal infection, see your doctor right away. They will work with you to provide a diagnosis, treatment plan, and discuss long-term outcomes with you.

Updated on: 08/10/21
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Discitis is a Spinal Disc Infection and Inflammation
Benjamin T. Bjerke, MD, MS
Rahul Shah, MD
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Discitis is a Spinal Disc Infection and Inflammation

Discitis is usually caused by an infection in the disc and/or disc space between two vertebral bodies, and affects the intervertebral disc.
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