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More frequently with patients on immunosuppressive drugs like steroids for transplants, and autoimmune disorders, and with an ever increasing population of HIV and other immunocompromising disorders we are seeing an increase in spinal infections. The disc spaces are avascular and do not have good blood supply to fight infections. Often a diskitis will occur with a bacterial infection in the disc space. This sometimes will erode into the adjacent vertebral bodies and cause collapse of the body. Occasionally the infection will start in the vertebra itself.
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Spinal cord tumor thoracic spine, a rare cause of back pain |
Sometimes infections can be treated with long term antibiotics of 6 weeks or more. If there is a moderate size abscess on scans and large amount of dead or necrotic tissue, surgery will often be recommended. Here the abscess is drained from the front or back of the spine and bone graft may be placed initially to reconstruct the spine or later after antibiotic sterilization of the infections. These require 6 to 12 weeks or longer antibiotics given intravenously. Rarely there may be an epidural abscess as a cause of low back pain. This can be from an injection of epidural steroids which infected that space.
One infrequent problem that can be associated with low back pain is a cauda equina syndrome. In this entity, pressure from a herniated disc on the sacral nerve roots, which supply the bowel and bladder, produces loss of function. This is a surgical emergency and should be evaluated immediately to maximize chance for recovery.
Sometimes gastrointestinal problems like appendicitis, gall bladder disease and pancreatitis as well as cardiac pain or angina may radiate through into the back and these also need to be evaluated. A primary care physician or emergency room doctor may be the best to evaluate these worrisome and sometimes dangerous conditions.
For more information on low back pain, click here.
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