Spondylodiscitis: Difference between revisions

No edit summary
No edit summary
Line 93: Line 93:
<u></u><u></u>2. <u>Surgery</u> <ref name="2." /><ref name="3." /><ref name="5." /><ref name="10.">J.J. Rasker et al., Spondylodiscitis in Ankylosing Spondylitis, Inflammation or Trauma?, Scand J Rheumatol, 1996; 25: 52-7. Leven of evidence: C</ref>  
<u></u><u></u>2. <u>Surgery</u> <ref name="2." /><ref name="3." /><ref name="5." /><ref name="10.">J.J. Rasker et al., Spondylodiscitis in Ankylosing Spondylitis, Inflammation or Trauma?, Scand J Rheumatol, 1996; 25: 52-7. Leven of evidence: C</ref>  


== Physical Therapy Management  ==
<h2> Physical Therapy Management  </h2>
 
<p>Prognosis seems to be good with conservative treatment including NSAID’s, rest, physiotherapy, and a corset.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="10." /> Wearing the corset for a period of 6–10 weeks is instead confirmed by most authors<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="5." />  
Prognosis seems to be good with conservative treatment including NSAID’s, rest, physiotherapy, and a corset.<ref name="10." /> Wearing the corset for a period of 6–10 weeks is instead confirmed by most authors<ref name="5." />  
</p><p>The role of the physiotherapist contains function recovering therapy (strength, coordination stability, mobility) if necessary. Exercises that increase muscle force and coordination are required, and back stability should be trained as well.
 
</p>
The role of the physiotherapist contains function recovering therapy (strength, coordination stability, mobility) if necessary. Exercises that increase muscle force and coordination are required, and back stability should be trained as well.  


== Key Research  ==
== Key Research  ==

Revision as of 20:32, 25 April 2016

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Lynn Leemans

Top Contributors - Ine Wittevrongel, Bo Hellinckx, Lucinda hampton, Admin, Kim Jackson, 127.0.0.1, WikiSysop and Claire Knott  

Search Strategy[edit | edit source]

Keywords: Spondylodiscitis + Diagnosis / Therapy / Epidemiology / Rehabilitation / Rehabilitation / Examination / Symptoms / Characteristics / Clinical

Search engines: Pubmed Web of knowledge PEDro

Definition/Description[edit | edit source]

Spondylodiscitis can be defined as a primary infection (accompanied by destruction) of the intervertebral disc (discitis), with secondary infections of the vertebrae (spondylitis), starting at the endplates Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It can lead to osteomyelitis of the spinal column Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It has a high morbidity and mortality and is a rare but serious infection.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title



Pathogens causing spondylodiscitis are staphylococci, Escheria coli and mycobacterium tuberculosis Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.Spinal infections can be described aetiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic. Pyogenic spinal infections include: spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis[Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title[1].
 


Clinically Relevant Anatomy[edit | edit source]

The intervertebral disc is located between adjacent superior and inferior vertebral bodies. It has a central nucleus pulposus, which surrounds the annulus fibrosis and cartilaginous endplates. When the intervertebral disc is axially loaded, most the weight will be absorbed by the nucleus pulposus while the annulus assists in diffusing compression forces, carried out on the nucleus. The cartilaginous endplates are located along the central osseous endplates of adjacent vertebral bodies, and overlie the superior and inferior margins of the nucleus pulposus.[2]

A typical vertebra (vertebral body) is composed by the following parts:

  • Body, the weight bearing part.
  • Vertebral arch, which protects the spinal cord.  
  • Process spinosus
  • Processes transverse, left and right.
  • Articular processes, two superior and two inferior, that help to restrict the movements.[3]


Epidemiology /Etiology[edit | edit source]

According to scarce researches, the incidence of spondylodiscitis is 2.4/100,000 inhabitants. It increases with age. [4],[5] Men are up to three times more often affected than women.[6],[4] Predisposing factors include age, multimorbidity, diabetes mellitus, cardiovascular diseases.[4] The causes of spondylodiscitis are assigned to a large number of bacteria, fungi, which is to be taken into consideration in diagnostic treatment of patients. The main causative organisms are staphylococci [7],[5],[6] and mycobacterium tuberculosis.[5],[8]


Characteristics/Clinical Presentation[edit | edit source]

The clinical examination includes inspection concentrating on local changes and taking a detailed neurological status. There is pain on heel strike, impaction, and percussion, but little local pain on pressure. The patient takes a relieving posture and avoids stressing the ventral sections of the spinal column. In particular, inclination and re-erection are described as being painful.[4]


The symptoms of spondylodiscitis are non-specific.

  • Back or neck pain [7],[6],[9]
  • Radicular pain radiating to the chest or abdomen is not uncommon.
  • Neurological deficits, such as leg weakness, paralysis, sensory deficit and sphincter loss, are present in a third of cases.[7]
  • Fever (less commonly) [7][6]
  • Spinal deformities, predominantly kyphosis and gibbus formation, are commoner in tuberculous spondylitis.[7]
  • Weight loss [7][6]

According to N. Bettini et al, an increase in the pain symptoms is observed when digital pressure was applied to the vertebral area and the pain also irradiated to the homolateral periumbilical area. Also patients suffered radicular irradiation in the sciatica or crural fascia area.

Differential Diagnosis[edit | edit source]

Differential diagnoses include:

  • Erosive osteochrondrosis  
  • Osteoporotic and pathological fracture
  • Cancer related destruction
  • Ankylosing spondylarthritis
  • Scheuermann's kyphosis.[4]

Diagnostic Procedures[edit | edit source]

Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population.[7] The basic diagnostic examinations to establish spondylodiscitis are:

Outcome Measures[edit | edit source]

add text here..

Examination[edit | edit source]

add text here..

Medical Management[edit | edit source]

1. Conservative treatment:

This treatment is based on antibiotics and immobilization of the spine.[10] It can be considered when the clinical symptoms and destruction are relatively mild or the risk of operation is too great. The main problem in conservative treatment is to achieve adequate fixation of the affected section of the spinal column. Reclining ortheses distribute the stress over the unaffected spinal column joints, thus decreasing stress in the infected ventral area. The mobilization of the patient is only recommended once osseous infiltration becomes visible. Aside from the risk of immobilization, there is a high rate of pseudoarthroses (16% to 50%), which may eventually lead to kyphotic malposition and chronic pain syndrome. If there is no fusion reaction, continuing destruction, when the symptoms persist or worsen[6] , or there’s no clinical improvement, it is not promising to continue conservative treatment beyond four to six weeks.[4] Although protracted bed rest used to be prescribed, this practice is now being abandoned. There’s also a correlation between early diagnosis and successful results obtained with suitable conservative treatment.[4]

2. Surgery [7][4][6][11]

Physical Therapy Management

Prognosis seems to be good with conservative treatment including NSAID’s, rest, physiotherapy, and a corset. Wearing the corset for a period of 6–10 weeks is instead confirmed by most authors

The role of the physiotherapist contains function recovering therapy (strength, coordination stability, mobility) if necessary. Exercises that increase muscle force and coordination are required, and back stability should be trained as well.

Key Research[edit | edit source]

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources
[edit | edit source]

  • Pubmed (VUB BIBLIO)
  • Web of Knowledge  
  • Pedro

Recent Related Research (from Pubmed)[edit | edit source]

see tutorial on Adding PubMed Feed

Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10

References[edit | edit source]

see adding references tutorial.

  1. ↑ 16
  2. ↑ A.L. Baert et al., Imaging in percutaneous musculoskeletal interventions, Springer, 2009, 120p. Level of evidence: D
  3. ↑ V. Singh, General anatomy, Elsevier, 2008, 113p. Level of evidence: D
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Cite error: Invalid <ref> tag; no text was provided for refs named 3.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Cite error: Invalid <ref> tag; no text was provided for refs named 4.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 N. Bettini et al., Evaluation of conservative treatment of non specific spondylodiscitis, Eur Spine J, 2009, 18 (Suppl 1):S143–S150. Level of evidence: B
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Cite error: Invalid <ref> tag; no text was provided for refs named 2.
  8. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named 9.
  9. ↑ C.J. Kalisvaart et al., De diagnostiek van spondylodiscitis, Ned Tijdschr Geneeskd, 1993; 137, nr 32. Level of evidence: C
  10. ↑ 10.0 10.1 Cite error: Invalid <ref> tag; no text was provided for refs named 1.
  11. ↑ J.J. Rasker et al., Spondylodiscitis in Ankylosing Spondylitis, Inflammation or Trauma?, Scand J Rheumatol, 1996; 25: 52-7. Leven of evidence: C

 


 

Retrieved from "https://www.physio-pedia.com/index.php?title=Spondylodiscitis&oldid=140976"