If left untreated, spine infection can lead to paralysis or even fatality. Signs of spine infection include back pain, fever and a stiff back as well as possible swelling or inflammation of the spine, sensory deficit or numb, motor weakness or paralysis.
Prof. Prakit Tienboon, M.D., Director of the Revision Spine Center, shares his expert knowledge on how bacterial infection of the spine can penetrate into the body in three ways: 1) directly through the spine by, for example, being stabbed or direct puncture wound; 2) by spreading from infections in areas near the spine; and 3) through the blood stream, especially when the immune system is weakened.
Spine infection can be categorized into two groups. Firstly, acute infection is usually caused by virulent bacteria which inflict patients with high fever, severe back pain and a stiff back. In serious cases, patients will be unable to move, walk or sensory loss or total paralysis. However, the infection may not be sign of inflammation as commonly occurs in other kinds of infection. The second type of spine infection is categorized as a mild infection or low grade infection in medical term, which is usually the result of tuberculosis developing gradually. In the early stage, patients or doctors may not be aware that existing back pain is actually caused by an infection as there may be no fever or only a very mild fever. In some cases, patients may have low fevers for several days and only find out about the infection when it has developed to a serious level. In more severe cases, pus drains from the spine infection and spreads to the soft tissue and to skin, and patients’ backs can become crooked.
Spine infection can occur in three regions (excluding direct infection in the spinal nerve): spinal discs, the spine bone, and the spinal canal. The infection in the spinal canal is the most severe, and can lead to paralysis or fatality within 48–72 hours if the condition is not diagnosed and treated quickly. Delays in treatment may also result in an inability to cu re the infection or require a long recovery period.
Fortunately, most instances of spinal infections are mild and caused by tuberculosis. Should patients not be diagnosed or treated early enough, their backs will become crooked at the terminal stage of infection. In contrast, infection in the spinal discs tends to be very severe, causing agonizing back pain, back stiffness, and high fever. However, patients with these symptoms tend to be diagnosed very soon.
Prof. Prakit Tienboon, M.D. further notes that prior to commencing treatment, it is very important to determine which stage of infection the patient is in and what the cause of the infection is. The doctor will first conduct a blood test to check the white blood cells, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Next, the patient will receive a severity test, such as an x-ray, CT SCAN or MRI to help determine the infection’s level of severity. A bone scan enables the type of infection to be identified quickly within 24 hours. Another method of diagnosing the type of infection is by hemoculture. It is vital that the doctor ascertains the type of the infection and its severity in order to prescribe the correct antibiotics to deal with the infection.
The treatment of spine infections depends on the severity and the type of infection. It may be necessary to use antibiotics as the main medication. Surgery may not be required for every patient but can be performed 1) to determine the type of infection and to conduct a severity test in order to be able to prescribe the appropriate antibiotics; 2) to cure the nervous system; or 3) to treat instability or severe weakness of the spine; 4) to correct spinal deformity.
“To prevent spine infection, notice whether you have frequent back pain or a series of fevers. These symptoms may be the result of a mild spine infection, especially one that is caused by tuberculosis. This type of infection can still be found in Thailand as it can be transferred in a person’s breath, especially when the immune system of our body is weak,” advises Prof. Prakit Tienboon, M.D.
Bachelor of Science, Chulalongkorn University, 1972.