Epidemiology

Etiology

Routes of infection

• Hematogenous spread from a distant focus (e.g., skin and soft tissue infection, urinary tract infection)
• Direct inoculation (e.g., during spinal surgery or due to trauma)
• Contiguous spread from adjacent infections (e.g., aorta, esophagus)

Pathogens

• Common
  • Staphylococcus aureus (most common, accounting for > 40% of cases)
  • Escherichia coli (second most common)

Risk factors

• Age > 50 years
• Sickle cell disease
• Immunocompromise: e.g., steroid use, HIV infection
• Intravenous drug use
• Recent bacteremia
• Infective endocarditis
• Recent spinal surgery and instrumentation
• Intravascular devices
• Malnutrition
• Chronic medical conditions:
  • Diabetes mellitus

Pathophysiology

Clinical features

Diagnostics

Imaging studies

MRI spine

• Indication: first-line imaging modality for suspected spinal infection (highest sensitivity)
• Modality: MRI spine with and without IV gadolinium contrast

Treatment