Overview of the Complications and Sequelae in Spinal Infections

Key points

Sequelae of postoperative infections

The postoperative spine is discussed separately, because symptoms, clinical presentation, and complications may differ widely. Postoperative spondylodiscitis occurs in 0.1% to 4% of all spinal procedures, depending on the literature. It commonly occurs 1 to 4 weeks after surgery, chemonucleolysis, and even diagnostic interventional procedures and accounts for 20% to 30% of all cases of spondylodiscitis.4, 6 It typically presents with severe back pain, with or without radiculopathy.4, 6

It is a

Extraspinal spread of infection

If spondylitis or in rare occasions septic facet arthritis is left untreated it can directly spread to the surrounding tissues. This could result in phlegmon or abscess formation in the surrounding soft tissues and even in the epidural space (see Fig. 2). In general epidural involvement is reported in 32% of the cases.1, 2, 4, 5, 10

A phlegmon is the inflammation caused by tissue infiltration. Abscess formation with necrosis, however, is a collection of pus. It is differentiated by T1-weighted

Fractures and malformation

The vertebral body primarily serves as a load-bearing structure. Destruction of the disk and subchondral bone causes a decrease in disk height, whereas long-lasting infection can cause reactive sclerosis, new bone formation with osteophytes, and even bony ankylosis. Therefore, gradual destruction of the intervertebral disks, cortex, and trabeculae can cause local instability and collapse of the vertebral body (Fig. 8, Fig. 9, Fig. 10).

Over time these structural changes can gradually result in

Neurologic complications

In the acute phase spondylodiscitis can lead to spinal and foraminal stenosis. Mechanical compression is the most common cause of functional compromise of the spinal cord. Ischemic compromise of the spinal cord is seldom seen. Phlegmon and abscess formation can cause nerve root irritation, leading to radicular pain, such as pain in the neck, chest, or abdomen (see Figs. 3 and 5).1, 10

Only rarely does the infection spread to the meninges and then is called spinal meningitis.¹ It is caused by

Summary

Spinal infection is spectrum of diseases involving the bone, disks, and/or ligaments. There has been written evidence of the complications since ancient Egyptian civilization, with mostly spinal deformation. Treatment was mainly based on managing the deformity.

Mortality rates were around 70% before the use of antibiotics.⁵ However, because of the indolent course, there is still an important delay in diagnosis with a mortality rate between 2% and 11%, according to the literature.

A fast diagnosis