Discitis
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, vertebral artery dissection.
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.