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When a pain| in the back| can be fatal

Jun 03. 2013
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By Prof Prakit Tienboon, MD

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Most of us suffer from back pain at some point in our life and for the majority of us, it's down to little more than a strain or bad posture.
But when that back pain is accompanied by fever, stiffness or numbness and motor weakness, then it’s likely that a spine infection has set in.
A bacterial infection of the spine can penetrate the body in three ways: first, directly through the spine by, for example, being stabbed or a direct puncture wound; second, by spreading from infections in areas near the spine; and third, through the blood stream, especially when the immune system is weakened. 
Spine infections are categorised into two groups. An acute infection is usually caused by virulent bacteria, which inflict patients with high fever, severe back pain and a stiff back. In serious cases, patients will be unable to move or walk and may suffer sensory loss or total paralysis. There may however be no signs of the inflammation that commonly occurs in other kinds of infection. 
The second type of spine infection is categorised as a mild or low-grade infection and is usually the result of slowly developing tuberculosis. In the early stages, neither patient nor doctor may be aware that existing back pain is actually caused by an infection as there may be no fever or only a very mild fever. In more severe cases, pus drains from the spine infection and spreads to the soft tissue and to the skin.
Excluding direct infection in the spinal nerve, infection can occur in three regions: the spinal discs, the spine bone, and the spinal canal. The infection in the spinal canal is the most severe, and can lead to paralysis or fatality within 48 to 72 hours if the condition is not diagnosed and treated quickly. Delays in treatment may also result in an inability to cure the infection or require a long recovery period. 
Fortunately, most instances of spinal infections are mild and caused by tuberculosis. Should patients not be diagnosed or treated early enough, their backs will become crooked during the terminal stage of infection. In contrast, infection in the spinal discs tends to be very severe, causing agonising back pain, back stiffness and high fever. Patients with these symptoms tend to be quickly diagnosed.
Prior to commencing treatment, the doctor must determine the stage of the infection and its cause. He or she will first order a blood test to check the white blood cells, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). An x-ray, CT SCAN or MRI will be used to help determine the infection’s level of severity while a bone scan enables the type of infection to be identified within 24 hours. 
Hemoculture is another diagnositic method. Once the type and severity of the infection have been ascertained, antibiotics can be prescribed. 
Surgery is not required for every patient but might be performed to determine the type of infection and to conduct a severity test in order to be able to prescribe the appropriate antibiotics. It may also be needed to cure the nervous system, to treat instability or severe weakness of the spine or to correct spinal deformity. 
Anyone experiencing frequent back pain or a series of fevers should consult a doctor. These symptoms may be the result of a mild spine infection, especially one that is caused by tuberculosis. This type of infection can still be found in Thailand as it can be transmitted from person to person, especially when the immune system is weak.
Prof Prakit Tienboon, MD, is director of the Revision Spine Centre at Samitivej Srinakarin Hospital. Call (02) 378 9000

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