Discitis

Discitis or diskitis is an infection in the intervertebral disc space that affects different age groups. In adults it can lead to severe consequences such as sepsis or epidural abscess but can also spontaneously resolve, especially in children under 8 years of age. Discitis occurs post surgically in approximately 1-2 percent of patients after spinal surgery.

1. Discitis  or  D iskitis Discitis  or  diskitis  is an  infection  in the  intervertebral disc space  that affects different age groups. In adults it can lead to severe consequences such as  sepsis  or  epidural abscess  but can also spontaneously resolve, especially in children under 8 years of age. Discitis occurs post surgically in approximately 1-2 percent of patients after spinal surgery.

2. Symptoms include severe back pain, leading to lack of mobility. Some very young children may refuse to walk and arching of the back is possible. In post-operative situations, the symptoms occur within a week and result in severe low back pain or neck pain (depending on the surgical location). If untreated, the discitis may resolve on its own, causing spontaneous fusion of the intervertebral disc space, cause a chronic low grade infection, or progress to  osteomyelitis  and possibly even an  epidural abscess . In case of concomitant inflammation of one or more vertebrae (in such cases usually the areas adjacent to the intervertebral disc spaces), the condition is called  spondylodiscitis .

3. There is debate as to the cause, although hematogenous seeding of the offending organism is favored as well as direct spread. It is important to differentiate between spontaneous discitis which is usually from  hematologic  spread from a urinary or respiratory infection versus that from a  post-operative complication  which usually involves  skin flora  such as  staph aureus . It can be caused due to  spinal tuberculosis  and spread along spinal ligament to involve the adjacent anterior vertebral bodies, causing angulation of the vertebrae with subsequent  kyphosis .

4. Diagnosis is usually apparent on  MRI  although plain X-rays and  CT examinations  can be suggestive. The MRI will reveal air changes in the disc and possibly even external involvement involving the bone or  epidural regions . A  biopsy  may be performed and helps with diagnosis in some cases but often an organism is not obtained.  C-reactive protein  levels and  ESR levels  will be elevated and are useful for treatment. Often, the  white blood cell count  will be normal and the patient will be  afebrile .

5. Treatment usually includes  antibiotics , and reducing the mobility of the affected region, either with a  back brace  or a  plaster cast . Without treatment, the patient may form an  abscess  which may need to be surgically corrected. Due to the poor  vascularity  of the disc, drugs required for treatment often include potent agents such as  Ciprofloxacin  along with  Vancomycin . Occasionally, oral drugs can be used to treat the infection but it may fail and IV drugs may be required. If the patient is an adult many surgeons and doctors now recommend moving little and often and within the pain limits of the medication. Discs respond to  osmotic pressure  therefore movement is beneficial to increase their blood flow and fluid dynamics. This is why disc patients are no longer told to bed rest. In children whether to bed rest or move a little is decided on an individual basis, depending on the site and severity of the discitis .

6. An infected disc at the level of C5 C6 causing neurological symptoms