Spinal infections typically begin in the disc tissue (discitis) and can progress to the vertebral body (spondylodiscitis) and the spinal canal located at the back. Conversely, they can also originate in the vertebral body and spread to other structures.
While the blood supply to the vertebral body is good, the disc tissue lacks vascularization and thus does not have adequate blood flow. This often results in antibiotic treatment alone being insufficient to penetrate the disc tissue adequately in spinal infections.
Spinal infections can spread from other tissues or organs (such as dental abscesses, respiratory or digestive system infections), or they can occur due to direct trauma, either surgical or non-surgical. The most common type is postoperative, meaning it occurs after surgery.
The most common symptom in patients is pain. Fever may accompany the pain. In some patients, abscess-related neurological deficits, such as weakness in the arms or legs and loss of bladder and bowel control, may occur.
Diagnosis of Spinal Infections
The initial diagnostic approach for patients should be imaging techniques, with MRI being the most effective method. For patients suspected of infection based on imaging, specific laboratory tests (such as CRP, sedimentation rate, procalcitonin, and tests for tuberculosis and brucellosis in certain cases) should be conducted. In some cases, a biopsy may be necessary to identify the specific type of infection through microbiological examination.
Treatment of Spinal Infections
For simple spinal infections, treatment initially involves targeted antibiotic therapy and bracing. However, in advanced cases, antibiotic therapy alone may be insufficient. Surgical debridement to remove necrotic tissue and excise infected tissues is the most effective method for controlling the infection. For postoperative infections, reopening the surgical site and cleaning the infection is often recommended. Antibiotic treatment, particularly for infections like tuberculosis, may last up to a year, while for other specific infections, at least 3 weeks of intravenous antibiotics followed by 3 weeks of oral antibiotics is required. However, this duration varies for each patient. In some cases, the treatment period may be extended based on the patient's response and laboratory findings (CRP, sedimentation rate, procalcitonin), and additional debridement surgeries or vacuum-assisted closure (VAC) therapy may be necessary for wounds that do not close.