Discitis

• Discitis:

  • Uncommon but serious condition
  • Infection of intervertebral space
• Demographics:

  • Bimodal distribution
  • Children
  • Adults around 50 yrs
• Causes:

  • Direct inoculation - spinal surgery, LP, injections
  • Haematogenous spread from systemic infections e.g. UTI, pneumonia, soft tissue infection - IVDU is risk factor for this
  • Contiguous spread from local infection e.g. adjacent osteomyelitis in vertebrae
• Usually caused by single organism - most commonly staphylococcus aureus
• Presentation:

  • Back pain - localised to affected disc, doesn't tend to radiate
  • Fever
  • Anorexia and weight loss
  • Rarely neurological symptoms
• Examination:

  • Point tenderness over involved disc - lumbar region most common
  • Limited rage of movement due to pain
  • Usually normal lower limb neurological exam
• Investigations:

  • Bloods: raised inflammatory markers, WCC may be normal
  • MRI best for imaging
  • Biopsy can help make a definitive diagnosis and obtain culture of causative organism
• Treatment:

  • Analgesia
  • Prolonged IV antibiotics - usually 4-6 weeks
  • Bed rest +/- brace to immobilise spine
  • Consider surgery if no improvement