Nonsurgical treatment should be considered first when patients have minimal or no neurological deficits and the morbidity and mortality rate of surgical intervention is high. However, surgery may be indicated when any of the following situations are present:
- Significant bone involvement
- Neurological deficits
- Sepsis with clinical toxicity caused by an abscess unresponsive to antibiotics
- Failure of needle biopsy to obtain needed cultures
- Failure of intravenous antibiotics alone to eradicate the infection
The following questions, which are considerations in most spine surgeries, may present additional challenges in the presence of a spinal infection:
- Will the approach be anterior or posterior?
- Should fusion be performed?
- Is instrumentation beneficial?
The primary goals of surgery are to:
- Debride (clean and remove) the infected tissue
- Enable the infected tissue to receive adequate blood flow to help promote healing
- Maintain or restore spinal stability
- Limit the degree of neurological impairment
Once it is determined that the patient requires surgery, imaging tools such as plain x-rays, CT scans or MRI can help further pinpoint the level at which to perform surgery.
Current treatment protocols for spinal infections require treatment by a multidisciplinary team of physicians, including infectious disease experts, neuroradiologists, and spine surgeons. The team will be able to assess the best treatment approach on an individualized basis, whether it is surgical or nonsurgical.