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Lumbar Spine Infection

Introduction

Fortunately infection within the lumbar spine is uncommon. It may be quite hard to diagnose, but there are important features known as "red flags" that should alert doctors and patients of the potential problem.

Lumbar spine infections can affect the disc, and is called discitis, the bone, and is called osteomyelitis, or occasionally the structures within the spinal canal in the form of an epidural abscess.

Even today, Tuberculosis is probably the most common form of infection within the lumbar spine followed by discitis and other bacterial infection in patients who's immune system is reduced. This can occur when patients are on long term drugs to suppress their immune system,(such as in organ transplants, people who's immune system doesn't work properly, (such as in diabetes, cancer or in some inherited conditions)' or in some patients who's immune system is nit working because of other infections such as HIV and AIDS.

The spinal infection within the lumbar spine presents as pain particularly at night sweats and weight loss and must be treated urgently as it constitutes one of the red flags.

Warning

An evaluation of red flags is contained within a separate sheet on the All About Spines website. If you are one of the patent groups mentioned in the introduction

Condition

Spinal infection in the lumbar spine is uncommon.

It may present as pain in the spine that is there even when resting, deformity of the spine, weight loss, night sweats and signs of nerve compression such as weakness or loss of sensation in the legs.

There are certain features in the history and examination, which are strongly suggestive of an infection and must be taken seriously.

History

Patients with infections of the spine may complain of night pain, sweats, weight loss and numbness, infections of the lumbar spine give numbness below the waist, while infections high up give numbness further and further up the body.

The presence of night pain, sweats and weight loss should alert the doctor to the possibility of infection, which should warrant urgent investigations.

Examination

Examination may reveal nothing at all or may reveal tenderness in particular regions, a deformity of the spine while examination of the lower limbs may reveal weakness due to nerve compression.

Special Investigations

Special investigations including MRI scan are probably the most helpful investigation although a bone scan and aspiration biopsy may be required.

Non-Surgical Treatment:

If the infection does not compress the spinal cord and of the spine is stable, then treatment might simply consist of antibiotics, into the veins initially and then orally. If there is a collection of pus, the treatment may consist of drainage using a needle that is passed under X-Ray or CT guidance.

Surgical Treatment

If the spinal cord is compressed, if there is instability of the spine or if there is another reason that conservative treatment is not possible, an urgent decompression may be performed either using a CT guided needle or by an operation to evacuate the pus and possibly fixation of the spine if it is unstable.

Decisions regarding stability can only be taken by trained spinal surgeons.

If the area involved by the infection is extensive this may require fixation of the spine and is something that should be performed by experienced spinal surgeons.

Warning

If a patient has symptoms suspicious of a spinal infection urgent advice should be obtained and appropriate treatment delivered as a matter of urgency.

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