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Infection of the Cervical Spine

The most common form of infection within the cervical spine is tuberculosis.

Although tuberculosis is considered by some to be a disease that is rapidly being eradicated, it is a condition that is increasing even in so called developed countries.

Other forms of infection affecting the discs are discitis because of common infecting organisms and may occur because of infection elsewhere.

Patient History

Patients who have infection within the cervical spine will complain of pain, weight loss, night sweats and particularly pain that occurs even at rest.

The weight loss, night sweats and occasionally shivers together with infection elsewhere should alert any treating doctor to the possibility of an infection within the spine.

Although a recent history of travel to countries such as India, Pakistan and Bangladesh may appear to be important, many cases within London occur in patients who do not have a history of travel to these countries and therefore the primary infection can be contracted in the United Kingdom before recurring later in life.

Examination

Patients who have infections of the cervical spine are tender when the spine is palpated, they are often hot tachycardic (a high pulse rate) and generally look unwell.

Special Investigations

Special investigations would include routine blood tests, x-rays, CT scans and MRI scans.

Natural History of Cervical Spine Infections

Infections of the cervical spine are a set of serious conditions that require prompt recognition and treatment.

The treatment involves getting a sample of the infected tissue so that the correct antibiotics can be administered.

If the infection is a simple bacterial infection, the antibiotics are often given intravenously for between two to six weeks and then given orally until a full three to six months of treatment has been completed.

If the infection is tuberculosis then the antibiotics are often given for up to a year.

Non-surgical Treatments

Many patients can be treated without resorting to operation. The treatment is therefore pain relief and the correct antibiotics.

If there is any deterioration in the neurological status of a patient with weakness in the arms or legs and increasing pain, an urgent reevaluation is required and surgical treatment considered.

Physical Therapy

There is no role for physical therapy in the acute management of a spinal infection.

Once the patient has improved maintaining a range of movements may be of assistance but this is not the primary concern.

Surgery

In patients who have infection that is not responding to antibiotics or with infections that are causing nerve compression or spinal cord compression urgent decompression is required.

Unfortunately because the infection often destroys disc or bone surgical stabilisation may be required.

The operation can be difficult and should be performed by surgeons trained in this surgical specialty.

It is important to recognise that if patients develop nerve compression or spinal cord compression, operations often do not reverse this compression and therefore early treatment or at least early observation is mandatory.

Overall

Overall infections of either the cervical intervertebral discs or the bones of the cervical vertebrae are characterised by pain, sweating, weight loss and in particular the pain is present even at rest.

If this condition is suspected, urgent investigations and treatment should be instituted in a centre specialising in this condition.

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