The treatment of an infection of the thoracolumbar spine depends on the severity of a patient’s symptoms and severity of neurologic compression and bony destruction. Patients are initially referred for a fine needle aspiration (FNA) or closed bone biopsy and culture to ascertain the specific type of bacteria that is causing the infection. Patients in whom the biopsy or aspiration fails and the results are indeterminate may be considered for open biopsy. Patients are generally treated with strong antibiotics for 4-8 weeks until the infection is eradicated.
Patients are usually indicated for surgical debridement if there is spinal instability, significant deformity, and/or neurologic deficit. This surgery removes bone and other infected or abnormal tissue. The doctor removes infected and damaged or dead bone. The area is then cleaned with a sterile solution that contains antibiotics. A paravertebral abscess causing sepsis, or any sized epidural abscess, is often an indication for emergent surgical intervention. An anterior or posterior decompression and fusion, or combined anterior/posterior surgery, may be utilized depending on where the infection and neurologic compression is most prominent.