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Inflammatory and Infectious Diseases of the Spine

Inflammatory disorders and infections can affect any area of the spine. This includes the bones comprising the vertebral column, the discs, the dural sac that covers the spinal cord as well as the area around the spinal cord. These disorders result from a wide variety of conditions and causes. Some of these disorders may be rare, but nonetheless result in significant pain and disability.

Incidence of spinal infections are on the rise. Since the 1990s, in addition to an increasingly aging population, there are greater numbers of those with compromised immune systems and intravenous drug users. Additionally, the use of epidural catheters for pain management and surgery that includes instrumentation have increased, thus increasing the risk of spinal infection.

Conditions

Below are a number of conditions associated with inflammation and infections of the spine.

Acute transverse myelitis, which prevents transmission of the nerve impulses in the spinal cord, is an inflammatory condition that impacts the entire width (transverse) of the spinal cord. 

Ankylosing spondylitis (AS) is a form of spinal arthritis, causing inflammation of the vertebrae and arthritis in the joints between the pelvis and the spine. It can be extremely severe, causing prolonged pain and discomfort. It can also result in the fusing of some of the spinal vertebrae, creating a less flexible spine and a hunched-over posture.

Discitis, an inflammation of the area between intervertebral spinal discs, is relatively uncommon and impacts only one out of every 100,000 Americans. It often occurs with osteomyelitis (see below).

Epidural abscess is an infection located in the spinal canal in the area around the dura (the covering of the spinal cord and nerve root). It is common in those with discitis (see above), or vertebral osteomyelitis (see below). It is most common in those age 50 and older.

Osteoarthritis (OA) in the spine occurs in the facet joints, which are responsible for providing flexibility of the back, enabling the body to bend and twist. A common cause of neck and back pain and stiffness, facet joint osteoarthritis (FJ OA) is common in older adults. Rheumatoid arthritis of the spine can also affect the facet joints.

Vertebral osteomyelitis (also referred to as discospondylitis) is the most common type of vertebral infection. It is often overlooked, as one of its primary symptoms is back pain, a common complaint among a wide portion of the population.

Causes

Spinal infections can be the result of either a bacterial or a fungal cause. This type of infection occurs in another part of the body and reaches the spine through the bloodstream. The most common cause of spinal infections is Staphylococcus aureus, a bacterium. While various risk factors contribute to the possibility of spinal infections, in large part—and despite precautions—they occur following surgery.

Symptoms

Symptoms of spinal infection may vary according to the cause, and can be subtle or severe. They include any of the following:

  • Back pain
  • Chills
  • Fever
  • Headaches
  • Muscle spasms
  • Painful or difficult urination or bowel dysfunction
  • Redness or tenderness at the site of infection
  • Tenderness in the spinal column
  • Stiffness in neck or back
  • Weakness, numbness or tingling in the arms or legs

In children: prolonged crying, pain or tenderness with palpitation of the back or hip area.

Diagnosis

Many inflammatory diseases of the spine can be diagnosed only with blood tests. Examples include ankylosing spondylitis and rheumatoid arthritis. In the case of a lesion or vertebral osteomyletis, a CT scan can reveal the extent of bone destruction, whereas an MRI is indicated to determine involvement of soft tissue.

Treatment

Spinal infections are largely treated nonsurgically with antibiotics or antifungal medications. Surgery may be indicated with certain conditions, and if medical management is not successful. Sometimes surgery is simply a matter of washing out an infected wound or removing infected tissue. Other possible indications for surgery include:

  • Abscess that is not resolved with antibiotics
  • Neurological deficits
  • Instability of the spine
  • Significant impact on bones

At University Orthopaedic Associates (UOA), we are specialists in the diagnosis and treatment of spine conditions. These include inflammatory disorders and infectious diseases when they occur. Contact us for an evaluation and treatment plan for any of your orthopaedic needs.

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