Discitis: Difference between revisions

Latest revision as of 15:01, 4 January 2021

Background

Infection in the intervertebral disc space
- occurs post surgically in approximately 1-2% of patients after spinal surgery.
Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised

Clinical Features

>90% present with unremitting neck or back pain which awakens them at night
- May have radicular symptoms
Fever (60-70%)
Neuro deficits (10-50%)
ESR elevation (>90%)
Leukocytosis (<50%)

Differential Diagnosis

CT of an infected disc at the level of C5-C6 causing neurological symptoms

MRI of discitis in a 2 year old child.

Spinal infection

Lower Back Pain

Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Spinal Infarct
Renal disease
Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
Pelvic disease
- PID
Other
- Retroperitoneal hemorrhage/mass
- Meningitis

Evaluation

Labs
- ESR elevated
Imaging
- Plain films are rarely positive
- MRI is gold standard

Management

IV Antibiotics

Treatment targets S. aureus, Streptococcus, Pseudomonas, E. coli

Inpatient Therapy

Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
- Ceftriaxone 2g IV daily
- Cefepime 2g IV IV three times daily
- Ceftazidime 2g IV three times daily
- Ciprofloxacin 400mg IV three times daily

Use cefepime or ciprofloxacin if targeting Pseudomonas spp

Disposition

Admit

References

Authors:

@@ Line 1: / Line 1: @@
 ==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
+*Infection in the intervertebral disc space
+**occurs post surgically in approximately 1-2% of patients after spinal surgery.
+*Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
+*Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised
 ==Clinical Features==
-Acute or sub-acute course with pain of affected area. Radicular Sx in 50-90%
+*>90% present with unremitting neck or [[back pain]] which awakens them at night
-Lumbar spine most common.
+**May have radicular symptoms
-Fever in 90%
+*Fever (60-70%)
-Pain with Range of Motion
+*Neuro deficits (10-50%)
-Usually no neurological deficits
+*ESR elevation (>90%)
-== Work-Up  ==
+*Leukocytosis (<50%)
-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.
+==Differential Diagnosis==
+[[File:Pinfecteddisc.png|thumb|CT of an infected disc at the level of C5-C6 causing neurological symptoms]]
+[[File:Discitis.jpg|thumb|MRI of discitis in a 2 year old child.]]
+{{Spinal infection types}}
-MRI is diagnostic. CT may show secondary bony abnormalities but not diagnostic for diskitis
+{{Lower back pain DDX}}
-ESR/CRP are high, CBC can be normal.
+==Evaluation==
-Usual pathogens: S. aureus, gram-negatives, fungal, TB.
+*Labs
+**ESR elevated
+*Imaging
+**Plain films are rarely positive
+**MRI is gold standard
-[[Image:Diskitis.jpg|thumb|right|381x525px|Diskitis.jpg]]
+==Management==
+===IV [[Antibiotics]]===
+{{Antibiotics Discitis-Vertebral Osteomyelitis}}
-<br>
+==Disposition==
+*Admit
-==DDx==
+==References==
-Any other neck/back pain DDX
+<references/>
-Rule-out Spinal epidural abscess, malignancy, spinal cord lesions
+[[Category:Orthopedics]]
-==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.
-[[Category:Ortho]]