Spinal infection & tumour

What it is

Infection can seed into a disc, a vertebra, or the space around the spinal cord, sometimes without an obvious source. Tumour in the spine is most often secondary — cancer that has spread from elsewhere — and much less commonly arises in the spine itself.

Both are uncommon compared with degenerative problems, but both are important not to miss, because the pattern of back pain they cause is distinctive and treatment is time-sensitive.

Features that raise concern

• Back pain that is worse at night or at rest, rather than with activity.
• Fever, sweats, unexplained weight loss, or feeling generally unwell.
• A history of cancer, intravenous drug use, recent bloodstream infection, or a suppressed immune system.
• Pain that is escalating steadily rather than fluctuating.
• New neurological symptoms in the legs.

How it is assessed

Blood tests for inflammation, MRI with contrast, and often a biopsy to identify the organism or the tumour type. Imaging of the rest of the body is arranged where a primary cancer needs to be found.

Treatment

Care is shared. Infection is usually treated with a prolonged course of targeted antibiotics directed by infectious diseases; surgery is added where there is an abscess compressing the cord, structural collapse, or failure to respond.

For spinal metastases, the plan is made with oncology and radiation oncology. Surgery is used where the spine is unstable, where the cord is compressed, or where pain cannot otherwise be controlled — always in the context of the wider treatment plan and the person’s overall condition.