Discitis
Encyclopedia
Discitis or diskitis is an infection
in the intervertebral disc space
that affects different age groups, but usually spontaneously affects children under 8 years of age. Nonetheless, discitis occurs post surgically in approximately 1-2 percent of patients status post spine surgery.
and possibly even an epidural abscess. In case of concomitant inflammation of one or more vertebrae (in such cases usually a the areas adjacent to the intervertebral disc spaces) the condition is called spondylodiscitis
.
such as staph aureus
.
The cause may be aseptic.
. A biopsy
may be performed and helps with diagnosis in some cases but often an organism is not obtained. C-reactive protein
levels and ESR levels
will be elevated and are useful for treatment. Often, the white blood cell count will be normal and the patient will be apyrexic.
or a plaster cast
. Without treatment, the patient may form an abscess
which may need to be surgically corrected. Due to the poor vascularity
of the disc, drugs required for treatment often include potent agents such as Ciprofloxacin
along with Vancomycin
. Occasionally, oral drugs can be used to treat the infection but it may fail and IV drugs may be required.
If the patient is an adult many surgeons and doctors now recommend moving little and often and within the pain limits of the medication. Discs respond to osmotic pressure
therefore movement is beneficial to increase their blood flow and fluid dynamics. This is why disc patients are no longer told to bed rest. In children whether to bed rest or move a little is decided on an individual basis, depending on the site and severity of the discitis.
Discitis in young children: From The Hospital for Children, London, England
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
in the intervertebral disc space
Intervertebral disc space
The intervertebral disc space is typically defined on an X-ray photograph as the space between adjacent vertebrae. In healthy patients, this corresponds to the size of the intervertebral disc...
that affects different age groups, but usually spontaneously affects children under 8 years of age. Nonetheless, discitis occurs post surgically in approximately 1-2 percent of patients status post spine surgery.
Signs and symptoms
Symptoms include severe back pain, leading to lack of mobility. Some very young children may refuse to walk and arching of the back is possible. In post-operative situations, the symptoms occur within a week and result in severe low back pain or neck pain (depending on the surgical location). If untreated, the discitis may resolve on its own, cause a chronic low grade infection, or progress to osteomyelitisOsteomyelitis
Osteomyelitis simply means an infection of the bone or bone marrow...
and possibly even an epidural abscess. In case of concomitant inflammation of one or more vertebrae (in such cases usually a the areas adjacent to the intervertebral disc spaces) the condition is called spondylodiscitis
Spondylodiscitis
Spondylodiscitis is a combination of discitis and spondylitis , the latter generally involving the areas adjacent to the intervertebral disc space.-Causes:...
.
Causes
There is debate as to the cause, although hematogenous seeding of the offending organism is favored as well as direct spread, e.g. following instrumentation. It is important to differentiate between spontaneous discitis which is usually from hematologic spread from a urinary or respiratory infection versus that from a post-operative complication which usually involves skin floraSkin flora
The skin flora are the microorganisms which reside on the skin. Most research has been upon those that reside upon the 2 square metres of human skin. Many of them are bacteria of which there are around 1000 species upon human skin from 19 phyla. The total number of bacteria on an average human has...
such as staph aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
.
The cause may be aseptic.
Diagnosis
Diagnosis is usually apparent on MRI although plain X-rays and CT examinations can be suggestive. The MRI will reveal air changes in the disc and possibly even external involvement involving the bone or epidural regionsEpidural space
In the spine, the epidural space is the outermost part of the spinal canal. It is the space within the canal lying outside the dura mater...
. A biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
may be performed and helps with diagnosis in some cases but often an organism is not obtained. C-reactive protein
C-reactive protein
C-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...
levels and ESR levels
Erythrocyte sedimentation rate
The erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
will be elevated and are useful for treatment. Often, the white blood cell count will be normal and the patient will be apyrexic.
Treatment
Treatment usually includes antibiotics, and reducing the mobility of the affected region, either with a back braceBack brace
A back brace is a device designed to limit the motion of the spine in cases of fracture or in post-operative fusions. Limiting the motion of the spine enhances the healing process and minimizes the patient's discomfort.Common back braces include:...
or a plaster cast
Plaster cast
A plaster cast is a copy made in plaster of another 3-dimensional form. The original from which the cast is taken may be a sculpture, building, a face, a fossil or other remains such as fresh or fossilised footprints – particularly in palaeontology .Sometimes a...
. Without treatment, the patient may form an abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
which may need to be surgically corrected. Due to the poor vascularity
Vascularity
Vascularity, in bodybuilding, is the condition of having prominent, visible veins.Vascularity is enhanced by extremely low body fat , low retained water, high blood pressure and muscle engorgement. Genetics will affect vascularity as well as ambient temperature. Some bodybuilders use topical...
of the disc, drugs required for treatment often include potent agents such as Ciprofloxacin
Ciprofloxacin
Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...
along with Vancomycin
Vancomycin
Vancomycin INN is a glycopeptide antibiotic used in the prophylaxis and treatment of infections caused by Gram-positive bacteria. It has traditionally been reserved as a drug of "last resort", used only after treatment with other antibiotics had failed, although the emergence of...
. Occasionally, oral drugs can be used to treat the infection but it may fail and IV drugs may be required.
If the patient is an adult many surgeons and doctors now recommend moving little and often and within the pain limits of the medication. Discs respond to osmotic pressure
Osmotic pressure
Osmotic pressure is the pressure which needs to be applied to a solution to prevent the inward flow of water across a semipermeable membrane....
therefore movement is beneficial to increase their blood flow and fluid dynamics. This is why disc patients are no longer told to bed rest. In children whether to bed rest or move a little is decided on an individual basis, depending on the site and severity of the discitis.
External links
- Learning Radiology: Damage appears on an X-ray image
Discitis in young children: From The Hospital for Children, London, England