Vertebral Osteomyelitis: Rare Spinal Infection Can Cause Severe Back Pain

Written by Rick C. Sasso, MD

Vertebral 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 rare and 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 CT scan (below) shows an example of an osteomyelitis in a vertebral body.

Typical Symptoms of Osteomyelitis
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.

Immediate treatment is necessary particularly because of possible neurologic deficit (eg, paralysis).

An x-ray reveals the location of the infection, any bony alterations or changes, 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 (eg, nerves).

If an abscess is present, a procedure called percutaneous needle aspiration (through the skin needle biopsy) may be done to collect a sample of the infection for identification. When needle biopsy (aspiration) is insufficient, open biopsy is surgically performed, which may include debridement (surgical removal of the infection).

Nonoperative Treatment
Spinal infections are often treated without surgery. Intravenous antibiotics 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 treatment fails, neurologic deficit presents, deformity develops or progresses, or infected bone or tissue removal is required.

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 treat spinal deformity and to provide permanent stability to the spinal column. These procedures join and stabilize the level where a spinal element has been damaged or removed (eg, vertebral body).

Instrumentation may involves the use of rods, screws, interbody devices, plates, or other devices to stabilize the spine. Fusion may involve the patient's own bone (autograft) and/or allograft (donor bone), or other types of graft materials. Fusion is the process by which new bone grows around and into the surgical area eventually healing and joining the spine together.

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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