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Beyond Antibiotics: Transforming Spinal Infection Treatment

Although fairly rare, spinal infections vary significantly. Among the most common are osteomyelitis, discitis, and epidural abscess. Osteomyelitis is an infection of the vertebral bone of the spinal column. Discitis, an infection of the disc space, involves an inflammatory lesion of the intervertebral disc. An epidural abscess is an infection that develops in the space around the dura, the tissue that surrounds the spinal cord and nerve root.


Osteomyelitis patients are generally ill with fever and severe back pain. Systemic symptoms such as chills, weight loss, difficult or painful urination, and intolerance to light may be present. If the disease has progressed, neurological symptoms may also be present. If there has been prior surgery, there may also be drainage from a wound or incision.

Discitis patients have few symptoms at first, but go on to develop severe back pain.

Generally, children do not have elevated temperature or complain of severe pain, but will refuse to flex the spine.

Epidural abscess symptoms are generally less obvious, often consisting of little more than a pins and needles sensation or mild weakness. Symptoms of post-operative infections include drainage from the wound, severe pain, fever, hematoma, and redness and swelling at the site of the incision.


Osteomyelitis can be caused by either a bacterial or a fungal infection elsewhere in the body that has been carried into the spine through the blood stream. The most common source is a bacterium called Staphylococcus aureus. The veins in the lower spine come up through the pelvis. For this reason, spinal infections may occur after a urologic procedure (e.g., cystoscopy). Tuberculosis, although much more prevalent in underdeveloped countries, can also cause this type of infection.

Although most researchers believe discitis to be caused by infection, the cause has been the subject of some debate. The infection probably begins in one of the contiguous end plates, which leads to an infection in the disc. Due to improved surgical techniques and the use of peri-operative antibiotics, post-operative spinal infections have become increasingly rare. However, a small percentage of such cases still occur.

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MRI is usually the diagnostic tool used to confirm spinal infections. It can determine the presence and extent of any infection and the presence of spinal cord compression.

Treatment Options

Long-term antibiotic therapy, including both oral and intravenous therapies, is usually required for the treatment of osteomyelitis. If the vertebrae continue to deteriorate and if conservative treatments have been exhausted, surgery may be required to remove the infected fusion and stabilize the spine. Most doctors treat discitis with plaster cast immobilization, an effective treatment in most cases. In some cases, antibiotics are also prescribed. The treatment for an epidural abscess involves the removal of the infected tissue and administration of antibiotics.

Spinal Infections Specialist

Spinal infections cause severe back pain, and without prompt treatment, can turn into a chronic problem. At Center for the Functional Restoration of the Spine in Shrewsbury, Toms River, and Edison, New Jersey, you receive exceptional care for spinal infections from Steve Paragioudakis, MD, and Marc Menkowitz, MD. The team offers comprehensive care, from accurately diagnosing infection to long-term treatment encompassing antibiotics and surgery to remove affected tissues when needed. To schedule an appointment, call the nearest office or book an appointment online today.

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Spinal Infections Q & A

What type of spinal infection might I develop?

What symptoms develop due to a spinal infection?

How do specialists treat spinal infections?

What type of spinal infection might I develop?

Spinal infections develop when bacteria, fungi, or other microorganisms travel to your spine through the bloodstream. The infection may originate in another part of your body, or the microorganisms may come through a wound, spine trauma, or during a surgical procedure. The three most common spinal infections include:

Vertebral osteomyelitis

Vertebral osteomyelitis is an acute or chronic bone infection.


Discitis occurs when the intervertebral discs develop an infection.

Epidural abscess

An epidural abscess develops when pus accumulates in the epidural space surrounding your spine.

What symptoms develop due to a spinal infection?

Spinal infections typically cause pain, but the symptoms vary depending on the type of infection. Vertebral osteomyelitis causes one or more of the following:

  • Back pain
  • Fever
  • Chills
  • Fatigue
  • Weight loss
  • Muscle spasms
  • Intolerance to light
  • Pain during urination
  • Difficulty urinating
  • Urinary or bladder incontinence
  • Weakness or numbness in your arms or legs
  • Swelling or drainage from the incision

You won’t have symptoms at the start of discitis; then, the infection gradually progresses to cause severe back pain. As an epidural abscess enlarges, it causes pain and possibly a fever. If it presses against spinal nerves, you may experience pain or tingling that radiates down your arms or legs.

How do specialists treat spinal infections?

Your provider at the Center for the Functional Restoration of the Spine reviews your medical history, performs a physical examination, and runs blood tests to check for an infection. They also order an MRI, which confirms the presence and extent of infection. An MRI also shows spinal cord compression. Since bacteria cause most spinal infections, the first line of treatment includes antibiotic therapy. Many patients with vertebral osteomyelitis need long-term oral and intravenous antibiotic therapies to eliminate them. When severe or chronic osteomyelitis causes ongoing vertebral deterioration, you may need surgery to clean away the infection and stabilize the spine. In addition to antibiotics, the team at the Center for the Functional Restoration of the Spine treat discitis with a cast or brace to immobilize your spine and promote healing. They take care of an epidural abscess by removing the infection. If you develop back pain, especially if it comes together with a fever and urinary symptoms, call the Center for the Functional Restoration of the Spine or book an appointment online.

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