Infection

      Just like any part of the body, the spine is very vulnerable to infection. Any structures in and around the spine can be infected.  The usual route is blood borne usually arising from another part of the body that is primarily infected.  The usual focus of infection is the vertebral body because it is a very vascular structure.  The earliest and most predominant symptom is pain. Fever may or may not be present. 



         Infection of the spine can be categorized  as acute or chronic.  The former is usually caused by pyogenic bacteria and the latter is usually caused by tuberculosis of the spine. The common denominator in spine infection is inflammation in and around the spine. This leads to the following signs and symptoms.

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Pain           - is usually very severe and localized

                  to the infected level.  Patients have

                  a hard time finding a comfortable

                  position.  Simple body movements

                  create intense pain. Simply touching

                  the patient can elicit pain.



Weakness   - can be secondary to the general

                    constitutional symptoms of general

                    body malaise.  Medical evaluation

                    is needed to determine subtle signs

                    of weakness due to compression of

                    the spinal cord and nerve roots due

                    to accumulation of pus into the

                    spinal canal. 



Deformity   - deformity seldom occurs in infection

                   unless damage to the integrity of the

                   spine  anatomy  has  been  set  in.  

                   Acute  infection  seldom  causes 

                   deformity unless it is neglected.  It is

                   common  in  chronic tuberculosis  of 

                   spine  where  the  spine  anatomy

                   ​is slowly destroyed by the infection.

 

Cauda Equina Syndrome   - is a "surgical emergency."                      Patients would usually experience severe                      leg pains with sudden weakness of both                        lowers.  There would be an associated                          urinary or bowel incontinence.  This                              signifies severe cord compression that                          necessitates immediate decompressive                        surgery.

 

Paralysis    -deformity or cauda equina syndrome                            usually precluded paralysis. Paralysis

                   is a late sequela usually due to neglect

                   of immediate treatment.  It is usually                            caused by compression of pus into the                          spinal canal, cord compression due  to

                   collapse of anatomy  and vascular

                   injury  due  to the  intense inflammatory                        process involved  in infections.

      Once a verterbal body is invaded by infection, it can spread by contiguity to adjacent structures.  Pus can dissect up and down between the planes of the bones and ligaments.  There can be multiple level of involvement if proper treatment is not instituted.  Infection can create space occupying lesions that can compress the cord or thrombose vital circulation to the neural structures. Immediate medical attention can prevent the spread of infection and destruction of too many structures.