Discitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
Acute or sub-acute course with pain of affected area. Radicular Sx in 50-90% | Acute or sub-acute course with pain of affected area. Radicular Sx in 50-90%. | ||
Lumbar spine most common. | Lumbar spine most common. | ||
Fever in 90% | Fever in 90% | ||
Pain with Range of Motion | Pain with Range of Motion | ||
Usually no neurological deficits | Usually no neurological deficits | ||
== Work-Up == | == Work-Up == | ||
Revision as of 15:21, 11 September 2011
Background
Infection of nucleus pulposus due to infection of vertebral body endplates cartilage. 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.
DDx
Any other neck/back pain DDX Rule-out Spinal epidural abscess, malignancy, spinal cord lesions
Treatment
IV antibiotics
Depending if osteomyelitis present may need surgical intervention.
Disposition
Admission with Spine service (Ortho or Neurosurgery)
Source
Marx: Rosen's Emergency Medicine, 7th ed.