Osteomyelitis is an infection of the bone, usually caused by bacteria or fungi. It is commonly found in the bones of the spine, but it can also spread into the discs between the bones and the area surrounding the spinal cord. The infection can also occur in the bones of the feet in patients with diabetes or in bones that have been injured or undergone surgery. Osteomyelitis can occur at any age, but it is most common in young children and the elderly.
- Ongoing, severe back pain that is worse with movement
- Swelling, warmth, redness and tenderness at the site of the infection
- Weight loss
When the infection is in the back, the patient may have back pain or muscle spasms but no fever. If the infection invades the space that surrounds the spinal cord, the patient may have severe, radiating back pain with muscle weakness and paralysis.
If the condition cannot be completely cured, it may turn into a low-grade form of the condition that comes and goes for months or years. This form may occur with bone pain, tenderness and sinus drainage. Because bone infections often block blood vessels, parts of the bone die. This leads to the spread of the infection, and abscesses that drain through the skin may develop.
Causes and Risk Factors
The staphylococcus aureus bacteria from a wound or a contaminated needle usually cause the acute form. A combination of microbes, including tuberculosis, HIV and others that affect immunity usually are responsible for the chronic form. Anyone who has a debilitating disease, cancer or diabetes or has had radiation therapy, dialysis or intravenous drugs has a higher risk of this infection.
In addition to taking a medical history and performing a physical exam, a doctor may order:
- Blood tests
- X-rays. Three to four weeks after the infection has set in, it may be visible on X-rays.
- Bone scans using radioisotopes can reveal problems sooner than X-rays. They do not, however, show whether the problems are due to infection, fractures or tumors.
- Taking a sample of the bone tissue for examination under a microscope (biopsy).
Antibiotics may be used to treat osteomyelitis. If antibiotic treatment fails, the infection may need to be surgically removed. Surgery may include draining the infection, removing infected bone and rebuilding the spine. Spinal instrumentation and fusion may be used to correct spinal deformity and provide permanent stability to the spinal column.