Surgery for Spondylodiscitis, Vertebral Osteomyelitis & Epidural Abscess
What Is This Surgery?
Spinal Infection Surgery is performed to treat infections affecting the vertebrae, intervertebral discs, spinal canal or surrounding soft tissues when non-surgical treatment alone is insufficient.
Spinal infections can occur due to bacterial, fungal or, less commonly, other infectious organisms. These infections may involve the disc space (Discitis), vertebrae (Osteomyelitis), epidural space (Epidural Abscess) or a combination of these structures.
Depending on the location and severity of infection, surgery may be performed using minimally invasive techniques (MIS), tubular surgery or conventional open surgery.
Why Is This Surgery Performed?
This surgery may be recommended for:
Spondylodiscitis
Vertebral Osteomyelitis
Epidural Abscess
Persistent Spinal Infection despite antibiotics
Neurological Deficits due to infection
Spinal Instability caused by infection
Progressive Vertebral Destruction
Severe Mechanical Back Pain
Diagnostic Uncertainty requiring biopsy
Common symptoms that may lead to surgery include:
Persistent severe back pain
Fever
Night sweats
Unexplained weight loss
Difficulty walking
Leg weakness
Numbness
Progressive spinal deformity
Failure to improve with medical treatment
Who Is A Suitable Candidate?
You may be a suitable candidate if:
✓ Infection is causing spinal instability
✓ Neurological symptoms have developed
✓ Significant vertebral destruction is present
✓ MRI shows spinal cord or nerve compression
✓ Antibiotic treatment alone has failed
✓ Severe pain is limiting mobility
✓ A tissue diagnosis (biopsy) is required
✓ Progressive deformity is developing
How Is The Surgery Performed?
Step 1
The procedure is performed under general anesthesia.
Step 2
The affected spinal level is identified using advanced imaging guidance.
Step 3
The infected tissue, pus collection or abscess is carefully accessed.
Step 4
Samples are collected and sent for microbiological and pathological analysis to identify the infecting organism.
Step 5
The infected and damaged tissue is thoroughly cleaned and removed (debridement).
Step 6
If the spinal cord or nerves are compressed, decompression is performed.
Step 7
If spinal instability is present, fixation using screws and rods may be required.
Step 8
The wound is irrigated, cleaned and closed.
The exact surgical approach depends on the location, severity and extent of infection.
What Are The Advantages?
Potential benefits include:
Removal of infected tissue
Relief of spinal cord or nerve compression
Accurate diagnosis through tissue sampling
Reduction in pain
Improved mobility
Restoration of spinal stability
Prevention of progressive deformity
Facilitation of targeted antibiotic treatment
Improved quality of life
Surgery often complements antibiotic therapy and helps achieve infection control in complex cases.
What Are The Risks?
Every surgical procedure carries certain theoretical risks and potential complications. However, every effort is made to minimise these risks through meticulous planning, advanced technology and comprehensive patient optimisation.
At Bombay Spine Clinic™, Spinal Infection Surgery is performed using modern imaging guidance, microsurgical techniques and minimally invasive approaches whenever appropriate. These techniques allow effective infection clearance while minimizing tissue disruption.
In addition, every patient undergoes a multidisciplinary assessment involving infectious disease specialists, physicians, cardiologists, anaesthetists and other specialists when required. This collaborative approach helps optimise patient safety and improve outcomes.
Potential risks that are discussed with patients include:
Infection recurrence
Bleeding
Dural tear (CSF leak)
Nerve injury
Persistent pain
Persistent neurological symptoms
Implant-related complications (if fixation is performed)
Delayed healing
Failure to completely eradicate infection
Rare need for additional surgery
Fortunately, the incidence of major complications is reduced through careful patient selection, targeted antimicrobial therapy and meticulous surgical technique.
Preparing For Surgery
Before surgery:
Clinical evaluation
MRI review
CT scan review
Blood investigations
Infection markers (ESR, CRP)
Blood cultures (if required)
Medical fitness assessment
Medication review
Anaesthesia assessment
Patients should inform their doctor regarding:
Diabetes
Heart disease
Kidney disease
Previous infections
Current antibiotic treatment
Previous surgeries
Allergies
What Happens During Hospital Stay?
Day of Surgery
Hospital admission
Surgery
Recovery room observation
Pain management
Monitoring of neurological function
First 24–72 Hours
Assisted mobilization
Physiotherapy guidance
Wound care
Monitoring of infection markers
Review of culture reports
Discharge
Most patients are discharged within:
3–7 days
depending on the severity of infection, overall medical condition and recovery.
Some patients may require prolonged antibiotic therapy after discharge.
Recovery After Surgery
Week 1
Expected symptoms:
Surgical site discomfort
Improvement in infection-related pain
Walking encouraged under supervision
Continued antibiotic therapy
Weeks 2–6
Follow-up consultations
Review of culture results
Monitoring of ESR and CRP
Gradual increase in activity
6 Weeks–3 Months
Continued recovery
Progressive strengthening exercises
Improvement in mobility and function
Long-Term Recovery
Recovery depends on the severity of infection, overall health and response to antibiotic therapy.
Most patients experience significant improvement in pain, function and quality of life following successful infection control.
Frequently Asked Questions
1. Why do I need this surgery?
Because the infection is causing nerve compression, spinal instability, severe pain or is not responding adequately to medical treatment alone.
2. Can spinal infections be treated without surgery?
Many spinal infections can be treated with antibiotics alone. Surgery is generally recommended when there is instability, neurological compromise, abscess formation or failure of conservative treatment.
3. Will tissue samples be taken during surgery?
Yes. Tissue samples are usually collected during surgery to identify the infecting organism and guide targeted antibiotic treatment.
4. How long will I stay in hospital?
Most patients remain in hospital for approximately 3–7 days, although this may vary depending on the severity of infection and medical condition.
5. When can I start walking after surgery?
Most patients are encouraged to begin walking within 24–48 hours under supervision, depending on the extent of surgery and overall condition.
6. When can I start outdoor walking?
Outdoor walking is generally started after approximately 1–2 weeks depending on comfort and recovery.
7. When can I travel after surgery?
Short local travel is usually possible after approximately 2–3 weeks. Long-distance travel is generally recommended after 6–8 weeks.
8. When can I return to work?
Typical timelines are:
Work From Home (WFH): Approximately 3–4 weeks
Office-Based Work: Approximately 6–8 weeks
Light Physical Work: Approximately 8–12 weeks
Heavy Manual Labour: Individualized based on recovery and infection control
9. When can I drive, exercise, dance or resume sports?
Driving is generally permitted after 4–6 weeks.
Sports, gym workouts and high-impact activities are usually resumed after 3–6 months depending on recovery and spinal stability.
10. What is the success rate of Spinal Infection Surgery?
When performed for appropriate indications and combined with targeted antibiotic therapy, Spinal Infection Surgery has a high success rate in controlling infection, relieving pain and improving function.
The outcome depends on factors such as the type of infection, severity of disease, neurological status and overall health.
11. Can the infection come back?
Recurrence is uncommon but can occur in certain situations. Careful follow-up, completion of antibiotic treatment and regular monitoring help reduce this risk.
Myth vs Fact
Myth:
A spinal infection always causes permanent disability.
Fact:
Early diagnosis and appropriate treatment can successfully control infection and allow many patients to return to normal activities.
Myth:
Antibiotics alone can treat every spinal infection.
Fact:
While many infections respond to antibiotics, some patients require surgery to remove infected tissue, decompress nerves or stabilize the spine.
If you have been diagnosed with a spinal infection, persistent unexplained back pain, or have been advised spine surgery for infection, you may schedule a consultation or upload your MRI, CT scan and blood reports for specialist review.
Dr. Siddharth KatkadeConsultant Spine Surgeon
Bombay Spine Clinic™
Need Clinical Evaluation?
Consult with Dr. Siddharth Katkade (MBBS, MS, DNB, FASSI Germany/UK) for accurate diagnosis and personalized spine treatment.
