Spondylodiscitis

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Original Editors - Lynn Leemans

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Search Strategy

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

Search engines: Pubmed Web of knowledge PEDro

Definition/Description

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.[1][2][12][15] It can lead to osteomyelitis of the spinal column.[3][2] It has a high morbidity and mortality and is a rare but serious infection.[1][12][13][15][17]

Pathogens causing spondylodiscitis are staphylococci, Escheria coli and mycobacterium tuberculosis.[1][2][4][5][12][14][16]
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. [1][16]

Clinically Relevant Anatomy

The intervertebral disc is located between adjacent superior and inferior vertebral bodies and links them together. The function of the disc is particularly mechanical, namely transmitting loads arising from body weight and muscle through the spinal column.[21] It has a central nucleus pulposus, which surrounds the annulus fibrosis and cartilaginous endplates. When the intervertebral disc is axially loaded, most of 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.[6]
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.[7]

In the beginning of pyogenic spondylodiscitis the anterior aspect of the vertebral end plate will abrade. Also loss of disc height, gradual development of osteolysis and further destruction of the subchondral plate will manage. Later on there will be more destruction of the vertebral body, new bone formation and kyphotic deformity. Because of the erosion of the vertebral end plates, the vertebra can collapse.[19][20] Tuberculous spondylodiscitis is also identified by the loss of the anterior subchondral part of the vertebral body. The difference between the two types, is that the intervertebral disc and the joint space are preserved longer in the tuberculous spondylodiscitis.[19]

Epidemiology /Etiology

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Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

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Outcome Measures

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Examination

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Medical Management

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2. Surgery

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Key Research

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Resources

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Recent Related Research (from Pubmed)

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