Spinal infection

Adults do not have a vascularized intervertebral disc (provided with blood vessels) so the arrival of germs that can cause infection through the blood is less frequent.

However, infection in children's vertebrae occurs more frequently because they do have vascular channels that end near the intervertebral disc, and this makes it easier for germs to implant in it. The origin can be other infected parts of the body or contamination by external agents. 

The microorganisms that affect the spine are usually bacteria (staphylococci), and, on some occasions, fungi. Generally, there is a history of infection in other areas of the body (genitourinary, skin, respiratory tract) that, through the blood (hematogenous spread) is implanted in the vertebra or in the intervertebral disc. 

One of the most common reasons for infections in the vertebrae or in the intervertebral disc is post-surgery, after performing open surgery on the spine. In this case, the lesion is more favored in immunosuppressed patients (immune system that functions below the normal rate), diabetics, chronic pathologies, obesity, smokers, anemic or malnourished, and when long-term surgeries are performed. It can be an infection in superficial planes that causes an opening of the surgical wound, or it can infect deep planes with involvement of the muscles, fasciae, ligaments, vertebrae, and intervertebral disc.

Other causes may be injuries near the spinal column or penetration of contaminated foreign bodies to these structures.

The patient suffers pain in the area of the back or region of the affected spine and fever if it is an acute process.

If the germs have arrived through another infected organ such as the skin, the genitourinary system, or the respiratory tract, the symptoms of affection in the vertebrae are added to the affectation of these. Any infectious picture leads to apathy and general malaise, in addition to fever. However, the fundamental symptom of the involvement of the vertebrae due to a germ infection is pain focused on the affected part of the back.

If the infection increases in the vertebral body or in the intervertebral disc, it can produce a greater weakening of these, reaching necrosis and vertebral crushing. The progression of the pathology to the layers that cover the spinal cord or the peripheral nerves can cause neurological alterations.

When there is an infected surgical wound, it is common for its edges to open and a serous and purulent staining to occur through the wound (serum and pus). This infection can penetrate deep planes and increasingly affect more paravertebral structures with increased pain.

The diagnosis of these pathologies is difficult in case of infection through the blood (hematogenous spread), it is usually delayed and involves differential analysis with inflammatory, degenerative, or tumor diseases. To make the diagnosis of spinal infection processes and differentiation from other pathologies, the following is usually required: 

• Blood analysis. 
• X-ray studies. 
• CT and MRI. 
• Bone scintigraphy. 
• Sample collection for culture by puncture or directly from the affected bed, which may include soft tissues and infected bone. 

The treatment depends on the affectation and extension of the infection, as well as the type of germ causing it, requiring specific intravenous antibiotics. If samples are taken from the infected area, it is possible to analyse and cultivate them in the laboratory and obtain the germ causing the infection. In this way, the patient will take the most effective antibiotic for their treatment (antibiogram).

Spinal surgery is sometimes necessary for cleaning and debridement (removal of dead, damaged, or infected tissue to improve the health of remaining tissue) of all infected structures. If the infection progresses and vertebral subsidence and fractures occur, extended excision of the infected area and structural fixation may be necessary to prevent compression of the vertebrae, nerve roots, or spinal cord. 

Our traumatologists are pioneers in spine surgeries in Madrid.