Wirbelsäulenosteomyelitis

Spinal osteomyelitis (also called vertebral osteomyelitis) is an infection in one or more bones of the spine and often the disc space between them. Germs usually reach the spine through the bloodstream from another infection site or from surgery, injections, or trauma.​

1) What is this condition?

  • It is a bone infection that affects the vertebrae and often the disc, causing inflammation and gradual bone destruction.​

  • The most common symptom is constant, localized back pain that gets worse with movement; fever may be mild or absent.​

2) How serious is it?

  • It is serious and can be life‑threatening without treatment, leading to spinal collapse, spinal cord or nerve damage, and blood poisoning (sepsis).​

  • Even with treatment, it carries notable risks: one large series reported about 28% overall death rate at 5 years, especially in people with major other illnesses.​

3) Non‑surgical treatments

  • Prolonged antibiotics targeted to the specific germ (bacterial or, rarely, fungal), often:

    • Several weeks of intravenous (IV) antibiotics, followed by weeks to months of oral antibiotics (commonly totaling at least 6 weeks, sometimes longer).​

  • Rest and bracing: limiting heavy activity and sometimes using a brace to support the spine while the infection heals.​

  • Pain control with appropriate medicines, and treatment of risk factors like diabetes, immune weakness, or drug use.​

  • Close monitoring with blood tests and repeat imaging to confirm the infection is responding.​

4) Types of surgery that may be necessary

  • Surgical cleaning (debridement): removing infected bone, disc, and any pus collections around the spine.​

  • Decompression: removing bone or infected tissue pressing on the spinal cord or nerves.​

  • Stabilization/fusion: reconstructing destroyed vertebrae with bone graft, cages, screws, and rods to restore stability and alignment.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Eradicate the infection with antibiotics, relieve pain, and allow the spine to heal without major surgery whenever it is safe.​

    • Avoid unnecessary surgical risk in patients who are stable and improving on medical therapy.​

  • Surgery goals:

    • Control infection when antibiotics alone are not enough, relieve pressure on nerves or spinal cord, and stabilize a weakened spine.​

6) How surgery can “fix” the problem

  • Debridement reduces the amount of infected material, improving antibiotic effectiveness and lowering pressure from abscesses.​

  • Decompression directly frees nerves and spinal cord from squeezed, infected bone or abscess.​

  • Stabilization with screws, rods, and graft rebuilds a solid “bridge” across damaged segments, preventing collapse and painful motion while bone heals.​

7) Risks of surgery (general and specific)

  • General risks: bleeding, wound infection, blood clots, anesthesia and heart/lung complications—higher in patients who are older, septic, or medically fragile.​

  • Spine‑specific:

    • Nerve or spinal cord injury causing new or worse weakness, numbness, or bladder/bowel problems.​

    • Hardware failure or non‑healing of the fusion, sometimes requiring additional operations.​

8) Chances this surgery will work

  • In a matched cohort, patients who had surgery plus antibiotics had significantly lower rates of death or recurrence at 1 year than those treated without surgery.​

  • Early surgery (within 24 hours when indicated) is associated with fewer complications, lower death rates, and better neurologic outcomes than delayed operations.​

  • Most patients treated with appropriate antibiotics and, when needed, timely surgery achieve good infection control and improved pain and function.​

9) Possible complications from the surgery

  • Persistent or recurrent infection requiring repeat debridement and extended antibiotics.​

  • Wound breakdown or chronic drainage, especially in people with diabetes, poor nutrition, or smoking.​

  • Long‑term pain, stiffness, or deformity even after infection is cleared.​

10) Typical recovery from the condition

  • With treatment, many people recover from the active infection within about 4–6 weeks, but full recovery (strength, stamina, pain improvement) can take months.​

  • Without treatment, spinal osteomyelitis can lead to severe bone destruction, spinal collapse, neurologic damage, and life‑threatening sepsis.​

11) Typical recovery after surgery

  • Hospital stay covers IV antibiotics, pain control, and early mobilization, usually with a brace.​

  • IV antibiotics are continued for weeks, often followed by oral antibiotics; rehab helps restore walking, flexibility, and daily function.​

  • Improvement in pain and neurologic symptoms can be gradual; some deficits may not fully reverse if the cord or nerves were badly compressed or damaged.​

12) How long in the hospital

  • Many patients require at least several days to a couple of weeks in hospital for IV antibiotics, monitoring, and, if needed, post‑operative care.​

  • More severe infections with sepsis, neurologic injury, or complex reconstruction can require longer stays and later transfer to rehab.​

13) Long‑term outlook

  • With appropriate antibiotics, about 70–90% of patients can be cured of the infection, though some have lingering pain or reduced mobility.​

  • Long‑term survival depends heavily on age and other illnesses; one series found roughly 72% alive at 5 years.​

  • People with serious co‑conditions (kidney disease, heart failure, sepsis, or paralysis at presentation) have higher long‑term death and complication rates.​

14) Need for outpatient follow‑up

  • Regular follow‑up with infectious‑disease and spine specialists to monitor blood tests, adjust antibiotics, and track symptoms.​

  • Repeat imaging (often MRI) at intervals to confirm that infection and any abscesses are resolving and that the spine is stable.​

  • Ongoing physical therapy and pain management, and monitoring for any recurrence of fever, worsening back pain, or new neurologic signs, which require urgent reassessment.