see also:

• epidural abscess

• 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

• epidural abscess
• psoas abscess
• vertebral fracture
• sciatica
• neoplasia / cancer / tumours

• 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