Spondylodiscitis: Difference between revisions
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Revision as of 20:33, 25 April 2016
Original Editors - Lynn Leemans
Top Contributors - Ine Wittevrongel, Bo Hellinckx, Lucinda hampton, Kim Jackson, Admin, WikiSysop, 127.0.0.1 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]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management[edit | edit source]
1. Conservative treatment:
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2. Surgery
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Physical Therapy Management[edit | edit source]
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Key Research[edit | edit source]
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Resources
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- Pubmed (VUB BIBLIO)
- Web of Knowledge
- Pedro
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
see adding references tutorial.
- ↑ 16
- ↑ A.L. Baert et al., Imaging in percutaneous musculoskeletal interventions, Springer, 2009, 120p. Level of evidence: D
- ↑ V. Singh, General anatomy, Elsevier, 2008, 113p. Level of evidence: D
- ↑ 4.0 4.1 4.2 4.3 Cite error: Invalid
<ref>tag; no text was provided for refs named3. - ↑ 5.0 5.1 5.2 Cite error: Invalid
<ref>tag; no text was provided for refs named4. - ↑ 6.0 6.1 6.2 6.3 6.4 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
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Cite error: Invalid
<ref>tag; no text was provided for refs named2. - ↑ Cite error: Invalid
<ref>tag; no text was provided for refs named9. - ↑ C.J. Kalisvaart et al., De diagnostiek van spondylodiscitis, Ned Tijdschr Geneeskd, 1993; 137, nr 32. Level of evidence: C
