SPINAL INFECTIONS

What can Cause a Spinal Epidural Abscess?

Some of the most common causes of an epidural abscess are as follows:

• Previous back surgery or an invasive spine procedure.
• Infections of the circulatory system
• Cervical osteomyelitis (bone infection of the spine).
• Use of intravenous drugs
• Consistent sinusitis
• chronic Ear infections.
• Recent brain surgery
• A brain injury

Symptoms and Signs of a Spinal Epidural Abscess

The signs and symptoms of an epidural abscess vary according to the location of the abscess and may include:

• Disruption of consciousness.
• Problems with coordination and movement.
• Unusual sensations all over the body.
• Difficulty walking.
• Increased muscle weakness in both the legs and the arms.
• Inability to regulate bladder or bowel motions.
• Nausea or the sensation of vomiting.

Diagnosis of Spinal Infections

Because prompt treatment will avoid or minimize neurologic deficits, clinicians should consider spinal epidural abscess if patients have significant atraumatic back pain, especially if a tenderness exists over the spine, or if they have a fever or have recently had an infection or dental procedure. Characteristic neurologic deficits are more specific but may appear later, so delaying imaging until these neurologic deficits are present may increase the likelihood of a poor outcome. If a person has symptoms of an epidural abscess, the doctor may order magnetic resonance imaging (MRI). Therefore, an MRI provides detailed images of organs and structures within the body using a combination of large magnets, radio frequencies, and a computer.

The doctor will draw blood to perform a complete blood count (CBC) to determine if an infection exists. The amount of white blood cells increases during an infection. This occurs because white blood cells attack and destroy the organisms that cause the infection. In this case, blood cultures can identify the organism (bacteria or fungus) that produces the infection.

Imaging Tools

Imaging studies will determine the exact location and extent of a lesion. The specific imaging techniques used vary slightly depending on the location of the infection.

Spinal Epidural Causes

Bacteria typically cause spinal epidural abscesses. In his case, Staphylococcus aureus appears as the most prevalent organism, followed by Escherichia coli. Additionally, a fungal infection can cause an abscess in some cases. The following circumstances increase the likelihood of developing a spinal epidural abscess:

• Recent back surgery or invasive spine procedure.
• A bacterial infection in the blood.
• A boil (a pus-filled bump beneath the skin caused by an infected hair follicle), most commonly on the back or scalp.
• Spine-related bone infections (vertebral osteomyelitis).
• Immunodeficiency [for example, an acquired immunodeficiency syndrome (AIDS), chemotherapy, and immunosuppressive medications administered to organ transplant recipients].
• Spinal cord injury.

Spinal Infections

Spinal Infections also known as vertebral infections and spinal osteomyelitis, are infections that occur within the vertebrae, the bones of the spine. Bacteria, fungi, or even viruses can cause these infections. The most common symptoms include localized pain in the back that worsens with movement, tenderness to the touch, and potentially fever and chills. In severe cases, the infection can spread and compress the spinal cord, leading to neurological problems like weakness, numbness, or difficulty walking. Early diagnosis through imaging tests like MRI is crucial to identify the source of the infection and initiate prompt treatment with antibiotics or antifungal medications. Left untreated, vertebral infections can cause serious complications, including bone damage, spinal instability, and permanent nerve damage.

Treatment of Spinal Infections

Surgery and antibiotics or antifungals are commonly used to treat spinal epidural abscesses. In some cases, treatment may consist solely of antibiotics. Thus, antibiotics are typically administered for 4-6 weeks. If the abscess puts pressure on the spinal cord, the surgeon will perform surgical spinal cord decompression to reduce/remove the pressure. Moreover, the surgeon may perform a laminectomy to remove the lamina, a bone that covers the spinal canal, to decompress the spinal cord. Also, the removal of the lamina makes room for the spinal cord and allows it to function properly. In most cases, Doctors recommend a laminectomy for complicated infections.

If the abscess causes neurological symptoms like bladder/bowel dysfunction, via the cauda equina syndrome, the surgeon will immediately drain the abscess. After draining the abscess, the surgeon will order a culture to ensure that the medications prescribed are effective against the specific organism causing the infection. In cases where neural structures are compressed, immediate surgical decompression and drainage are required. As such, doctors will collect the abscess fluid for culture and diagnostic purposes. If left untreated, serious complications such as the following can occur:

• Infection within the skull or spine bones.
• Meningococcal meningitis (infection of the meninges).
• A spinal cord abscess
• Chronic back pain.
• Permanent nervous system or brain damage, including paralysis
• Untreated spinal epidural abscesses

Antimicrobial Therapy

Doctors recommend bed rest and parenteral antimicrobials to treat spinal epidural abscesses that do not compromise neurological function. However, due to the risk of progressive neurological dysfunction despite antimicrobial therapy, as well as the link between improved outcome and preoperative neurologic function, doctors will closely monitor the patient.  In addition, surgical intervention should occur at the first sign of deterioration. Medical management will occur in patients who possess neurological symptoms; patients who may experience complications during surgery; patients who possess complete paresis for more than 48-72 hours, or patients who experience extensive infections involving many vertebral levels of the neural axis.

When a significant surgery gets delayed and significant neurologic dysfunction occurs, or the patient becomes septic or critically ill, antimicrobials should get started. Also, empiric antimicrobial therapy should begin as soon as cultures are obtained and should cover both Gram-positive cocci (including methicillin-resistant S. aureus (MRSA), such as vancomycin) and Gram-negative bacilli (third- or fourth-generation cephalosporins, such as ceftriaxone, ceftazidime, or cefepime), especially in patients with distant Gram-negative infection or bacteremia.

There are no evidence-based recommendations for the duration of parenteral antimicrobials for spinal epidural abscesses that do not compress epidural regions. However, clinical efficacy usually suggests a course of 6 to 8 weeks of parenteral antimicrobials. Although some specialists will prescribe oral antimicrobials for an additional 1 to 2 months, close monitoring will occur.

Nonsurgical Treatment

Long-term intravenous antibiotic or antifungal therapy becomes necessary for spinal epidural abscesses, which can result in the patient being hospitalized for an extended period. In addition, immobilization may occur when there is significant pain or the possibility of spine instability exists. Once the organism causing the infection has been identified, antibiotic treatment should begin if the patient is neurologically and structurally stable. As such, doctors will prescribe antimicrobial therapy to patients for at least six to eight weeks. In the end, doctors will prescribe Individual medication based on the patient’s unique circumstances, including age.

Surgical Treatment of Spinal Infections

Finally, doctors should implement nonsurgical treatments first; however, if any of the following conditions exist, doctors will suggest surgery:

• Significant bone destruction, which causes spinal instability.
• Deficits in neurology.
• Sepsis with clinical toxicity caused by an antibiotic-resistant abscess.
• The needle biopsy was unable to obtain the required cultures.
• Intravenous antibiotics cannot eradicate the infection.

The primary goals of surgery:

• Remove infected tissue (clean and remove it).
• Allow sufficient blood flow to infected tissue to aid in healing.
• Restore spinal stability by instrumenting the unstable spine.
• Restore function or lessen neurological impairment.

When surgery becomes necessary, imaging tools such as plain X-rays, CT scans, or MRIs can help further pinpoint the area where surgery will benefit the patient.

Preventing Spinal Infections

Preventing spinal infections is an important aspect of patient care, particularly in surgical procedures involving the spine. Here are three common measures that our doctors at the Southwest Scoliosis and Spine Institute implement to prevent spinal infections:

• Antibiotic Prophylaxis: Before spinal surgery, doctors may administer antibiotic prophylaxis to reduce the risk of infection. This involves the administration of antibiotics before, during, and after the surgical procedure to help prevent the growth of bacteria and minimize the likelihood of infection. The specific antibiotics used and the duration of treatment may vary depending on the patient’s health status, the type of surgery, and the presence of any risk factors.
• Sterile Surgical Techniques: Surgeons follow strict sterile techniques during spinal surgeries to minimize the introduction of bacteria into the surgical site. This includes thorough hand hygiene, wearing sterile gloves and gowns, and using sterile instruments and equipment. The operating room environment is also maintained under controlled conditions to minimize the presence of bacteria.
• Wound Care and Monitoring: Proper wound care and monitoring are crucial in preventing infections. Surgeons and healthcare providers ensure that surgical incisions are closed properly and sterile dressings are applied. They also monitor the incision site for signs of infection, such as increased redness, swelling, warmth, or discharge. Post-operative follow-up appointments are scheduled to assess the healing process and address any concerns promptly.

Patient Instructions

In addition to these measures, patients are often educated about proper hygiene and wound care instructions to follow after surgery. This may include instructions on keeping the surgical site clean, changing dressings as needed, and avoiding activities that could increase the risk of contamination or infection.

It’s important to note that while these preventive measures significantly reduce the risk of spinal infections, they may not eliminate them entirely. If any signs of infection, such as increased pain, redness, swelling, or fever, develop following spinal surgery, it is crucial to seek immediate medical attention for proper evaluation and treatment.

Why Choose the Southwest Scoliosis and Spine Institute?

The following are just a few of the many reasons why patients might choose us.

• Expertise in the spine: The team of specialists at Southwest Scoliosis and Spine Institute is comprised of spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, surgeries to correct idiopathic scoliosis are complex and multi-step procedures.  Our Southwest Scoliosis and Spine Institute surgeons, with offices in Dallas, Plano, and Frisco, Texas, are specially trained and have years of experience performing these types of spine surgeries. We have seen over 100,000 patients and have performed over 16,000 operations.  If you or your loved one is experiencing back pain, we strongly urge you to call us for an appointment, and we will see you in less than 24 hours.

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Footnote

WebMD:  What to know about Spinal Infections