Plain radiographs are not helpful. This single study will define spinal cord compression and the status of the spinal cord, determine the presence and extent of the abscess, provide a diagnosis of co-existing osteomyelitis, and exclude a drainable paraspinal fluid collection. The indications for surgical decompression of the spinal cord would be an increasing neurological deficit, persistent severe pain, or increasing temperature and white blood cell count. Finally, the frequency of post-operative wound infections have increased with increased usage of spinal instrumentation. The advantages of rigidly fixing a spine with instrumentation in order to increase fusion rate and decrease post-operative external immobilization have become apparent.
Infection is a major disadvantage of implanting foreign bodies in the spine.
The use of prophylactic antibiotics helps but a small percentage cannot be avoided. It has recently been shown that in particular, smokers are a very high risk group for infection. The diagnosis of post-operative infections is usually based on drainage from the wound or extraordinary pain. Other signs are elevated temperature, hematoma formation, erythema and edema at the wound site, elevated erythrocyte sedimentation rate, and increased white blood cell count. Once an infection is suspected, prompt exploration of the wound is indicated in the operating room with the patient under general anesthesia.