Bacterial Spine Infections in Adults: Evaluation and Management

Bacterial spinal infections in adults can have notable adverse consequences, including pain, neurologic deficit, spinal instability and/or deformity, or death. Numerous factors can predispose a person to spinal infection, many of which affect the immune status of the patient. These infections are typically caused by direct seeding of the spine, contiguous spread, or hematogenous spread. Infections are generally grouped based on anatomic location; they are broadly categorized as vertebral osteomyelitis, discitis, and epidural abscess. In some cases, the diagnosis may not be elucidated early without a reasonable index of suspicion. Diagnosis is based on history and physical examination, laboratory data, proper imaging, and culture. Most infections can be treated with an appropriate course of antibiotics and bracing if needed. Surgical intervention is usually reserved for infections resistant to medical management, the need for open biopsy/culture, evolving spinal instability or deformity, and neurologic deficit or deterioration.