Spinal Infection Ch2
Evaluation and Treatment

To evaluate a possible spinal infection your doctor will need to examine your back. He will check for areas of tenderness or swelling, and he will watch you move, to see if you are favoring one side or the other, or if you're holding your back in abnormal position.

  

  

"it is a good screening tool"

Your doctor may order blood tests to check for infection. Two of the most common tests are the erythrocyte sedimentation rate and a white blood cell count.

The erythrocyte sedimentation rate measures how fast red blood cells settle to the bottom of a tube.  This is a test that checks for inflammation anywhere in the body.  It is not specific for spinal infection, but it is a good screening tool.

"White Blood Cell Count"

Your white blood cells are the cells that fight infections.  By checking your white blood cell count your doctor can tell if there is an infection somewhere in your body.  Again, this is not specific to a spinal infection, but it is a good screening tool. 

"depending on the extent of the infection"

Your doctor will probably order x-rays of your spine.  These will probably not show discitis or an epidural abscess, but an x-ray may show osteomyelitis, depending on the extent of the infection.

Your doctor may also order an MRI of your spine. This is a good study to evaluate an epidural abscess but it is less reliable for the evaluation of discitis.

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"determine a treatment plan"

If you have an epidural abscess, an MRI will show the size and the position of the abscess. With this information your doctor can determine a treatment plan.

Biopsies may be ordered, using a needle or open dissection, to try and find out what bacteria, or other organism, is causing the infection. This can be useful to help verify an infection and to help determine the best antibiotic to use.

"rarely able to get an adequate sample"

Many times when discitis is suspected, biopsies are not done because they are rarely able to get an adequate sample, or identify the cause of the infection. 

"not able to reliably identify the exact cause"

Discitis treatment is controversial because many times a true infection is never identified, and imaging and blood studies, are not able to reliably identify the exact cause of the pain.

Some doctors will treat this with immobilization in a plaster cast and in many cases this is sufficient to cure the problem.  Other doctors feel that antibiotics are necessary even when bacteria or a precise infection cannot be identified.

"surgical debridement may be required"

The treatment for osteomyelitis and an epidural abscess will depend on the extent of the infection.  If the infection is limited, you may be started on several weeks of IV antibiotics, while the doctors monitor your symptoms and your blood studies.

When there is osteomyelitis, with extensive involvement of the bone, surgical debridement may be required. After surgery you will require several weeks of IV antibiotics followed by several more weeks of oral antibiotics.

"several weeks of IV and oral antibiotics"

An epidural abscess, especially if it is causing lower extremity symptoms, may require surgery to remove the infection and decompress the nerves. This would be followed by several weeks of IV and oral antibiotics.

When there is an infection after surgery a second procedure may be required to wash out the infection and remove infected tissue. Then you would require a short course of antibiotic therapy and the doctors would monitor your symptoms and blood work.

"will resolve without permanent injury"

An infection in your spine is a serious condition that can have severe complications. When you have, or think you may have, a spinal infection you need to see your doctor immediately for evaluation and treatment.

In most cases, when an infection is caught early and treated correctly, it will resolve without permanent injury. If you delay getting a diagnosis, or postpone treatment, you risk permanent injury or even death if the infection gets out of control.

"you can get back to living your life"

If you're having symptoms that you think may be caused by a spinal infection, the sooner you see your doctor and get treated, the sooner your symptoms will resolve and you can get back to living your life.



  

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