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What Is It?
Osteomyelitis is an infection of the bone usually caused by bacteria.
In the spine it is commonly found in the vertebrae, although the infection can
spread into the epidural and intervertebral disc spaces. Osteomyelitis is most
common in young children and the elderly, but can occur at any age.
There are
two forms of osteomyelitis - acute and chronic. Staphylococcus aureus bacteria
are usually the cause of acute osteomyelitis, which may enter the bloodstream
through a wound or contaminated intravenous needle. Chronic osteomyelitis may
develop gradually from tuberculosis, AIDs, and other conditions affecting immunity.
The symptoms include persistent and severe back pain exacerbated by movement,
swelling, fever, sweating, weight loss, and malaise. Abdominal pain and sciatica
can be caused by infection in the lumbar spine. If the infection invades the
epidural space, severe back pain may accompany radicular pain, weakness, and
sometimes paralysis. Diagnosis
Immediate treatment is necessary particularly
because of possible neurologic deficit. An x-ray reveals the location of the
infection, any bony alterations, and loss of intervertebral disc height. A CT
Scan or MRI may be required to further evaluate the soft spinal tissues including
the neural elements (e.g. nerves).
If an abscess is present, a procedure called
percutaneous needle aspiration may be done to collect a sample of the infection
for identification. When needle biopsy (aspiration) is insufficient, open biopsy
is surgically performed, which might include debridement. Treatment
Spinal infections
are often treated without surgery. Intravenous antibiotics (or antimicrobial
drugs) are given in the hospital and may continue at home for four to six weeks.
Oral antibiotics may need to be taken for several months. Analgesics and bracing
may be used to control pain. Surgery may be considered if antibiotic (antimicrobial)
treatment fails, neurologic deficit presents, deformity progresses, or infected
bone or tissue removal is required. Surgery
Surgery may include infection drainage
procedures, debridement, removal of infected bone, and spinal reconstruction.
Spinal Instrumentation and Fusion are surgical procedures that may be used to
correct spinal deformity and to provide permanent stability to the spinal column.
These procedures join and solidify the level where a spinal element has been
damaged or removed (e.g. vertebra). Instrumentation uses medically designed
hardware such as rods, bars, wires, and screws. These devices hold the spine
straight during fusion. Fusion is the adhesive process joining bony spinal elements.
Recovery
Intravenous antibiotics or antimicrobial drugs given in the hospital
may continue at home for several weeks. Oral antibiotics or antimicrobial drugs
may need to be taken for several months, even following surgical treatment.
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