common sources of spinal infection
Vertebral osteomyelitis and discitis typically occurs from transmission of infection from an outside focus. Infection can also spread through adjacent tissue, from a spinal surgery, injections, direct invasive diagnostic procedures, or spread through the blood stream. Infection of the disc and bony vertebrae are, for the most part, treated similarly. The incidence of osteomyelitis increases with age. Risk factors include degenerative discs, endocarditis, history of spine surgery, diabetes, steroid exposure, immune-compromised states, and history of drug use. Staph aureus accounts for more than 50% of the bacterial infections. Pain is typically localized at the site of infection. Fever is not a good predictor of whether or not an infection is present. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) lab work is advised. Blood cultures and MRI of the spine should also be considered. Diagnosis is made with a CT guided biopsy and culture of infected tissue. Diagnosis may be inferred even if cultures and Gram stain are negative, but clinical suspicion exists. Antibiotic therapy is the mainstay of treatment. This treatment can last from 6 to 12 weeks with weekly ESR and CRP levels drawn. If there is evidence of abscess, nerve injury, or cord compression, a surgery may be considered. Relative rest and opioid pain management is recommended for the focal pain.