discitis
Table of Contents
vertebral osteomyelitis / discitis
see also:
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.
Aetiology
- most cases are haematogenous spread following bacteraemic episodes:
- staphylococcus skin infections (staph account for over 50% of cases)
- 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
Clinical features
- 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
DDx
- psoas abscess
- vertebral fracture
Initial Ix of suspected discitis
- 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
Mx of proven discitis
- 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
discitis.txt · Last modified: 2018/08/08 09:15 by 127.0.0.1