What it is
Infection can involve the disc, the vertebral bone, or the epidural space around the spinal cord. It reaches the spine through the bloodstream, after a procedure, or by spread from nearby tissue. Risk is higher with diabetes, immunosuppression, intravenous drug use, or recent bacteraemia.
It is uncommon enough that it is frequently missed for weeks, and the delay is usually the most damaging part.
Symptoms
- Severe, constant back or neck pain, typically worse at night and not eased by rest
- Fever and systemic illness — present in only about half of cases
- Localised tenderness
- Neurological change where the cord or nerves are compressed
How it is diagnosed
Blood tests show raised inflammatory markers, which is often the first objective clue. MRI with contrast is the investigation of choice. Blood cultures and, where needed, an image-guided biopsy identify the organism — which matters, because treatment is targeted antibiotics and targeting requires knowing what you are treating.
Non-surgical treatment
The mainstay. A prolonged course of intravenous and then oral antibiotics, directed by culture, with bracing for comfort and serial imaging and blood tests to confirm response.
When surgery is considered
Compression of the spinal cord or nerves, spinal instability or deformity from bone destruction, failure to respond to appropriate antibiotics, or the need to obtain tissue when a needle biopsy has not. The aims are to drain infection, decompress the nerves and restore stability.