Discitis

Background

Infection of nucleus pulposus due to infection of vertebral body endplates. Usually more common in Peds or post-op. Immunocompromised hosts are at higher risk

Clinical Features

Acute or sub-acute course with pain of affected area. Radicular Sx in 50-90% Lumbar spine most common. Fever in 90% Pain with Range of Motion Usually no neurological deficits

Work-Up

Plain x-rays to rule out other issues. X-rays are positive after 2-4weeks. In all spine x-rays look for endplate destruction. In C-spine assess pre-vertebral spaces.

MRI is diagnostic. CT may show secondary bony abnormalities but not diagnostic for diskitis

ESR/CRP are high, CBC can be normal.

Usual pathogens: S. aureus, gram-negatives, fungal, TB.

File:Diskitis.jpg

Diskitis.jpg

DDx

Any other neck/back pain DDX Rule-out Spinal epidural abscess, malignancy, spinal cord lesions

Treatment

IV antibiotics

Depending if there is Osteomyelitis consultants may operate.

Disposition

Admission with Spine service (Ortho or Neurosurgery)

Source

Marx: Rosen's Emergency Medicine, 7th ed.