Orthopaedic Conditions

CONDITIONS OF THE SPINE

• Spinal Infection

Spinal Infection (Discitis/Vertebral Osteomyelitis)- Spinal infections can occur in the bone (osteomyelitis) or the soft tissue (discitis). Discitis, or disc space infection, is an inflammation of the intervertebral disc—the "cushion" in between the vertebrae of your spine. It can occur in adults, but it is more common in children. The exact cause is the subject of debate, but most researchers believe that discitis is caused by infection that probably begins in one of the vertebral end plates. These end plates are on the top and bottom of each vertebra and give nutrition to the disc. The end plate can become infected and the infection can then spread into the disc. It's also possible that the infection begins elsewhere and travels to the disc. This results when infections elsewhere travel through the bloodstream to the spine. Ear infections, urine infections, and skin infections are some examples of infections that could lead to transient bacteremia and perhaps discitis. Once the disc becomes infected, it's difficult for it to fight the infection. The disc is the largest avascular organ in the body; avascular means that they do not have their own blood supply. That's why the discs have to get their nutrition and blood supply—including white blood cells to fight infection—from diffusion through the vertebral end plates. This is an inefficient way to fight infection. Most cases of discitis can be treated with antibiotic therapy, but in some instances, surgery may be required. When the vertebral bones are involved, this is termed osteomyeliits. Osteomyelitis can lead to destruction and weakening of the bone and subsequent fracture. This can lead to spinal nerve or spinal cord compression and the need for surgical intervention to remove infected tissue and stabilize the spine. These conditions can also occur after surgery when the surgical site becomes infected. This can lead to a difficult problem to treat and may require a combination of long term antibiotics and surgical revision with removal of spinal implants when deemed safe.