Spinal infections: diagnosis, clinical assessment and treatment

Spinal infection is a collection of a diverse group of pathologies. Untreated the consequences are generally severe. In spondylodiscitis early diagnosis can be challenging because of the initially non-specific symptoms. Once a diagnosis has been made clinicians must chose the correct antibiotics and ensure their administration for a sufficient length of time. Late pain and disability in adults is a common and disappointing outcome though children generally do much better. Infection is a common complication of spinal surgery, often presenting late. Modifiable risk factors should be addressed preoperatively and instrumentation and bone graft should be used only when necessary. In deformity surgery an attempt should be made to retain the instrumentation in those cases which present within 2 years of index procedure. Tuberculosis (TB) is endemic in the developing world and becoming increasingly common in the Western countries. Treatment is aimed at eliminating the disease, preventing deformity and avoiding neurological compromise all of which will be aided by an early diagnosis. The surgical management of late presenting TB can challenge even the most experienced surgeons. In spinal infections identification of the organism is vitally important. Prolonged antibiotic courses should be given and surgery should be utilised judiciously to improve outcomes.