Spinal Infections: Osteomyelitis, Discitis, and Epidural and Intramedullary Abscesses

The reason tor the recent resurgence of spinal infections is threefoldthe segment of the population that is aged or immunosuppressed is growing, the number and complexity of spinal procedures being performed are rising, and the number of resistant microbes is increasing. The treatment of spinal osteomyelitis, discitis. and intramedullary or epidural abscess requires a multidisciplinary team approach including an infectious disease consultant, a neuroradiologist, and a spinal surgeon. The advent of sophisticated imaging modalities has greatly facilitated the diagnosis, local ization, and characterization of these lesions. The diagnosis is made by clinical history. imaging, blood cultures, and, frequently, closed or open biopsies of the involved area. The cornerstone of treatment for spinal infection remains medical, consisting of appropriate antimicrobial therapy. Surgical intervention is indicated to obtain cultures, to secure a diagnosis, to relieve or prevent intractable pain, to maintain or restore spinal stability, and to prevent or reverse neurologic deterioration.