Surgery for spinal infections
What is it?
Spinal infections, though less common than other spinal disorders, can be severe and may require surgical intervention. These infections can involve different parts of the spine: the vertebrae (osteomyelitis), the intervertebral discs (discitis), or the space around the spinal cord (epidural abscess). The most common causative agents are bacteria, with Staphylococcus aureus being a frequent culprit. Fungal or tubercular infections, though rarer, can also affect the spine.
Surgery for spinal infections is considered in several scenarios:
- Failure of Non-Surgical Treatment: Persistent or worsening infection despite appropriate antibiotic or antifungal therapy.
- Spinal Instability: Infections causing significant destruction of the vertebral body or disc, leading to instability.
- Neurological Impairment: Compression of the spinal cord or nerve roots, resulting in neurological deficits.
- Drainage of Abscess: Accumulation of pus in the spinal canal or around the spine that needs to be drained.
Challenges in Spine Infection Surgery
- Identifying the Pathogen: Obtaining a sample for culture to identify the specific causative agent is crucial for targeted antibiotic therapy.
- Preserving Spinal Integrity: Balancing the removal of infected tissue with the preservation of spinal stability is a key challenge.
- Risk of Recurrence: There is a potential for the infection to recur, requiring close postoperative monitoring.
Procedure
Surgery for spinal infections is considered in several scenarios:
- Failure of Non-Surgical Treatment: Persistent or worsening infection despite appropriate antibiotic or antifungal therapy.
- Spinal Instability: Infections causing significant destruction of the vertebral body or disc, leading to instability.
- Neurological Impairment: Compression of the spinal cord or nerve roots, resulting in neurological deficits.
- Drainage of Abscess: Accumulation of pus in the spinal canal or around the spine that needs to be drained.
Surgical Approaches and Techniques
- Abscess Drainage: In cases of an epidural abscess, the primary goal is to decompress the spinal canal by draining the pus. This is typically done through a laminectomy, where part of the vertebra is removed to access the abscess.
- Debridement of Infected Tissue: Surgical removal of infected and necrotic tissue is crucial to manage the infection and prevent its spread. This may involve the resection of part of the vertebra or disc.
- Spinal Reconstruction and Stabilization: In cases where the infection has led to significant bone loss, causing instability, spinal reconstruction may be necessary. This involves using bone grafts and spinal instrumentation (rods and screws) to stabilize the spine.
- Anterior and Posterior Approaches: The surgical approach depends on the infection’s location. Anterior approaches are often used for vertebral body infections, while posterior approaches are common for epidural abscesses.