Spinal infections

What are Spinal Infections?

Like infections in other parts of the body, it can also affect the spine.

What causes it?

The most common cause of spinal infection in our country is tuberculosis. The other cause of infection is bacteria which may spread to the spine from a focus of infection in some other part of the body.

What are the symptoms/effects?

Spinal infection can lead to pain over the affected region of the spine, fever, loss of weight and appetite. In the later stages, it can lead to compression on the spinal cord and nerves causing varying degrees of muscle weakness and altered sensations.

How is it diagnosed?

Spinal infections are diagnosed by a thorough history and clinical examination of the symptomatic person and confirmed with x-rays and an MRI scan.

What are the treatment options?

Most spinal infections can be treated with antibiotics and surgery is required only in a few instances. The first step is to ascertain the exact bacteria or organism that is causing the infection and this may necessitate a biopsy. Once the organism is identified, the appropriate antibiotic is started.

Surgery is considered when a) there is no response to antibiotics, b) significant weakness in the limbs on presentation or worsening muscle strength while on antibiotic treatment and c) when destruction of the vertebrae causes a spinal deformity or instability. Surgery may be in the form of a decompression of the neural structures and may be supplemented with screws and rods to stabilise the spine.

Who is at risk? /How can I prevent it?

Advancing age, altered immune status, diabetes, intravenous drug abuse and a source of infection outside the spine are risk factors for the development of spinal infection.

Spinal Fractures and Dislocations

What is a Spinal Fracture?

The spine is composed of blocks of bone called vertebrae stacked one above the other with an intervening soft shock-absorber like tissue called a disc lying between each pair of vertebrae.

What causes it?

Normal vertebrae can fracture due to falls from a height, road traffic accidents and other high velocity accidents. Vertebrae can lose their strength due to osteoporosis and these osteoporotic vertebrae are susceptible to fractures from low velocity injuries. Massive injuries to the spine can result in a loss of the normal alignment of the spine – dislocations. Depending on the extent of the initial damage to the spinal cord, some spinal cord injuries are permanent whereas others recover over time.   

What are the symptoms/effects?

Fractures and dislocations of the spine can lead to spinal cord and nerve root injury causing varying degrees of muscle paralysis, sensory alterations and loss of bladder and bowel control.

How are they diagnosed?

Fractures and dislocations are diagnosed by a thorough clinical examination, followed by xrays, CT scans and MRI scans. The CT scan reveals the extent of the bony injury whereas the MRI scan provides information regarding spinal cord compression and ligamentous injury.

What are the treatment options?

There are two issues here – a) bone and ligamentous injury and b) neural injury. Many spinal fractures can be managed without surgery as bony injuries heal over time. However, in the presence of a massive ligamentous injury (e.g. fracture dislocations) operative stabilisation is advisable.

Complete damage to the spinal cord results in permanent paralysis and surgery does not alter the neurological outcome. However, surgical stabilisation in this instance may permit early institution of rehabilitation. Incomplete injuries may recover over time and there is a role for surgical decompression and stabilisation in this instance.

Who is at risk?/How can I prevent it?

Adhering to occupational health and safety rules and regulations, following traffic laws and avoiding excessive speed while travelling on the road will reduce the incidence of spinal cord injuries.

Spinal deformities – Scoliosis and Kyphosis

What are Scoliosis and kyphosis?

An alteration in the shape and alignment of the spine leads to a spinal deformity. Scoliosis is an abnormal sideward curvature of the spine and kyphosis is an abnormal forward curvature (hunch-back) of the spine.

What causes these diseases?

1. Congenital causes – Scoliosis and kyphosis can result from births defects in the vertebrae.
2. Idiopathic causes – In some instances, the exact cause is still not known.
3. Associated with other diseases and syndromes – Scoliosis may be a manifestation of diseases like Marfan’s syndrome, Neurofibromatosis, Cerebral palsy etc.

What are the symptoms/effects?

1. Early onset scoliosis (diagnosed below the age of 7 yrs) can affect the growth and maturity of the lungs and in severe cases can shorten the life span.
2. Scoliosis and kyphosis may increase in severity as the child grows.
3. Severe curves (more than 50-60 degrees) can progress even after skeletal maturity (after the growth is complete).
4. Unacceptable cosmetic appearance (subjective).

How are they diagnosed?

Scoliosis and kyphosis are diagnosed by a clinical examination and confirmed with x-rays (radiographs). MRI scans and CT scan help to delineate the bony pathology and assess the spinal cord and neural structures.

What are the treatment options?

Observation – Serial examinations and follow-up using x-ray’s may be performed when the curve is small and to assess whether it is getting worse.

Orthosis – Braces may be used in some varieties of scoliosis during the growing years.

Operation -  Surgery is advisable to curves that are progressing, in the presence of certain patterns of congenital vertebral defects or if the curve is more than 50 -60 degrees and when it is causing imbalance of the body shape.

Who is at risk?/How can I prevent it?

Early diagnosis and management is the key to a good outcome.

Osteoporotic vertebral fractures

What is an Osteoporotic vertebral fracture?

Osteoporosis is a condition characterised by fragile bones that can fractures with minimal trauma. Osteoporosis can lead to spinal vertebral fractures.

What causes it?

1. Primary osteoporosis – Type 1 – Post menopausal osteoporosis – due to estrogen deficiency.
2. Primary osteoporosis – Type 2 – Senile osteoporosis – due to advancing age.
3. Secondary osteoporosis – due to intake of certain drugs (long term steroid usage), chronic medical illnesses, bed bound patients etc.

What are the symptoms/effects?

Pain is the predominant symptom following an osteoporotic vertebral fracture. The pain is aggravated by activity and partially relieved by rest. Rarely, fragments from the fractured vertebra can compress the spinal cord or nerve roots causing pain, muscular weakness and altered sensations in the limbs.

How is it diagnosed?

Osteoporotic vertebral fractures are diagnosed by a thorough history and clinical examination and confirmed by x-rays and MRI scans. The MRI scans reveals the level of the lesion and the extent of neural compression (if present).

What are the treatment options?

A majority of patients with osteoporotic vertebral fractures can be managed with non-surgical treatment. The non-surgical treatment may consist of pain medications and rest. Occasionally a brace may be used till the pain subsides.

Surgery is indicated when the a) failure of symptoms to subside after non-operative treatment, b) significant weakness in the legs and feet at presentation and c) involvement of the bladder with difficulty in passing urine. The surgical options are variable and include vertebroplasty, kyphoplasty and fusion (with or without decompression).

Who is at risk?/How can I prevent it?

Osteoporosis can be prevented by adopting a healthy lifestyle, ensuring a balanced diet and exercising. Early diagnosis and treatment can reduce the incidence of fractures.