Vertebral Osteomyelitis: Rare Spinal Infection Can Cause Severe Back Pain

Written by Rick C. Sasso, MD

Vertebral osteomyelitis is a bone infection usually caused by bacteria. In the spine, it is often 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 it can occur at any age.

There are 2 forms of osteomyelitis: acute and chronic. Staphylococcus aureus bacteria often cause acute osteomyelitis—these bacteria may enter the bloodstream through a wound or contaminated intravenous (IV) needle. Chronic osteomyelitis may develop gradually from tuberculosis, AIDs, and other condition affecting immunity.

The computed tomography (CT) scan below shows an example of an osteomyelitis in a spinal bone.

What are the symptoms of vertebral osteomyelitis?
Vertebral osteomyelitis symptoms include back pain that may be described as severe, persistent, worse at night and/or aggravated by movement. Osteomyelitis can affect any region of the spinal column—cervical (neck), thoracic (mid back), lumbar (low back) and/or sacral (sacrum). Pain may radiate (eg, sciatica) or travel into other parts of the body (eg, arm, leg) depending on the affected level of the spine.

Nerve and/or spinal cord compression may cause unusual sensations such as tingling, numbness, and/or burning feelings. Serious nerve-related dysfunction that requires urgent medical attention include difficult walking, loss of manual dexterity (eg, buttoning a shirt), profound weakness, paralysis, and/or bladder or bowel problems (eg, incontinence).

Other physical symptoms may include swelling, fever, sweating, weight loss, vomiting, weakness, and/or malaise (an overall feeling of discomfort).

How is vertebral osteomyelitis diagnosed?
If you experience symptoms of osteomyelitis, you should seek immediate medical treatment. Seeing your doctor as soon as possible is important to help prevent potentially permanent and life-altering nerve damage (such as paralysis).

An x-ray may show the location of the infection, any bony alterations or changes, and loss of intervertebral disc height. Your doctor may also order a CT or magnetic resonance imaging (MRI) scan to further evaluate your soft spinal tissues, including your spinal 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. When needle biopsy (aspiration) doesn’t provide enough information, your doctor may surgically perform an open biopsy, which may include debridement (surgical removal of the infection).

Can vertebral osteomyelitis be treated without surgery?
Spinal infections are often treated without surgery. IV antibiotics are given in the hospital and/or in an outpatient facility and may continue at home for 4 to 6 weeks. Oral antibiotics may need to be taken for several months. Analgesics and spinal bracing may be used to help control pain.

When may surgery be recommended to treat vertebral osteomyelitis?
Surgery may be considered if:

What type of spine surgery treats vertebral osteomyelitis?
Surgery for vertebral osteomyelitis may include infection drainage procedures, debridement, removal of infected bone, and spinal reconstruction.

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

Instrumentation may involve 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 bone graft types. Fusion is the process by which new bone grows around and into the surgical area, eventually healing and joining the spine together.

Recovering from Vertebral Osteomyelitis Surgery
Intravenous antibiotics or antimicrobial drugs given in the hospital may be continued at home for several weeks after your spine surgery. Oral antibiotics or antimicrobial drugs may need to be taken for several months, even following surgical treatment. If you experience severe pain or new symptoms after surgery, don’t hesitate to call your doctor.

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Osteomyelitis: Vertebral Infection