The verterbal body is a favorite site of infection because of its good vascularity. Once infected its structural integrity can be affected causing it to collapse and compress on the sensitive spinal cord and roots.
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.
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
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.
When considering infections of the spine basic serological exams are needed. Imaging exams may also help in the diagnoses and the demarcation of the geographic extent of the infection. Your spine specialists would normally order one or combination of all these labs to fully evaluate your spine and offer the best management.
Blood exam - Complete Blood Count
Erythrocyte Sedimentation Rate
C- Reactive Proteins
Imaging - X-Rays
- CT Scans
- MRI with contrast medium