vertebral osteomyelitis / discitis

Introduction

infection of the intervertebral discs is a potentially serious problem with a risk of sepsis / septicaemia and spread to form ostemyelitis or epidural abscess and then irreversible neurology or worse.

most cases are haematogenous spread following bacteraemic episodes:
- staphylococcus skin infections (staph account for over 50% of cases)
- urinary tract infections (UTIs) / cystitis
- pneumonia
- intravenous drug users (IVDU) or injection drug use (IDU)
- etc
some are post-operative infections following spinal surgery in which case they tend to be due to skin flora
some arise after spinal needle procedures such as epidurals, LP, chemonucleolysis, etc
some are direct spread from:
- ruptured oesophagus
- diverticulitis / diverticular abscess
- renal abscess
some may spread from vertebral tuberculosis (TB)
some may be due to brucellosis
may be aseptic

severe midline back pain with spinal tenderness
fever may present early or be a late feature but only half develop fevers before diagnosis
in children, it may present as refusal to walk or arching the back

FBE, U&E, CRP, ESR, 2 sets of blood cultures
- the WCC is often normal, but the CRP and ESR are raised in over 80%
emergent MRI scan

early referral to neurosurgery
as the disc has poor vascularity, potent antibiotics may be needed such as ciprofloxacin / vancomycin
patients are usually best to keep mobilizing to maintain blood flow to the disc which otherwise will decline with bed rest
if abscess forms, it may require surgical drainage