What are the risks of spinal infection after anesthesia?

From the Guidelines

Spinal infections after anesthesia, particularly after spinal or epidural procedures, are rare but serious complications, and if suspected, immediate medical attention is crucial to prevent permanent neurological damage. The most common infection is an epidural abscess, which typically presents with back pain, fever, and neurological symptoms like weakness or numbness. According to the most recent study 1, the risk of infectious complications from intrathecal catheter use is likely related to both duration of catheter placement and the attention to asepsis during its insertion and subsequent management.

Risk Factors and Prevention

Risk factors for spinal infections include immunocompromised status, diabetes, and poor sterile technique during the procedure 1. Prevention focuses on strict aseptic technique during anesthesia administration. The infection occurs when bacteria, commonly Staphylococcus aureus, are introduced during needle placement or spread from bloodstream infections.

Diagnosis and Treatment

Treatment usually involves a combination of antibiotics and possibly surgical drainage. Empiric antibiotic therapy often includes vancomycin (15-20 mg/kg IV every 8-12 hours) plus ceftriaxone (2g IV daily) or cefepime (2g IV every 8 hours) until culture results are available, typically continuing for 4-6 weeks. Early diagnosis and treatment are crucial to prevent permanent neurological damage, so any unusual symptoms following spinal anesthesia should prompt immediate medical evaluation.

Key Considerations

• The mean incidence of postoperative instrumented spine infection is approximately 2% to 3% 1.
• The diagnosis of postintervention spine infection is a clinical challenge given an overlap of clinical symptoms such as neck or back pain between postoperative and spine infection patients 1.
• The identification of abnormal laboratory parameters, such as leukocytosis or elevated ESR or CRP, may increase the clinical suspicion for spine infection in the postintervention patient 1.
• Imaging is important for suggesting the diagnosis of spine infection, guiding percutaneous spine biopsy procedures, defining the full extent of infection for the purposes of determining medical and/or surgical management, and for possible clinical follow-up 1.

From the Research

Spinal Infection after Anesthesia

• Spinal infections can occur after anesthesia, and it is essential to recognize the signs and symptoms to initiate prompt treatment 2, 3, 4, 5.
• The most common cause of spinal infection is bacterial, with Staphylococcus aureus being the predominant pathogen 2, 3, 5.
• Risk factors for spinal epidural abscesses include:
  • Intravenous drug use
  • Alcohol abuse
  • Diabetes
  • Human immunodeficiency virus (HIV)
  • Cancer
  • Hepatic disease
  • Renal disease
  • Other immunocompromising conditions
  • Spinal procedures, such as spinal surgeries, paraspinal injections, and placement of epidural catheters or stimulators 5
• Clinical presentations of spinal epidural abscesses can be variable, but common symptoms include:
  • Fever
  • Back pain
  • Neurological changes, such as motor weakness, sensory changes, urinary retention, and bowel dysfunction 2, 3, 5
• Laboratory findings may include systemic leukocytosis and elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) 5.
• Magnetic resonance imaging (MRI) with gadolinium contrast is the preferred imaging modality for diagnosing spinal epidural abscesses 3, 5.
• Treatment of epidural abscesses includes obtaining blood cultures and prompt antibiotic administration, with early surgical evaluation to determine if operative intervention is warranted 2, 3, 4, 5.
• The duration of antibiotic therapy for spinal infections is controversial, with some studies supporting standard prophylactic antimicrobial treatment for 48 hours, while others demonstrate that extended therapy for one week or greater is necessary to reduce the risk of infection 6.