Spondylodiscitis
Original Editors - Lynn Leemans
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Search Strategy[edit | edit source]
Keywords: Spondylodiscitis + Diagnosis / Therapy / Epidemiology / Rehabilitation
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Definition/Description[edit | edit source]
Spondylodiscitis can be defined as a primary infection (accompanied by destruction) of the intervertebral disc, with secondary infections of the vertebrae.2,3 It can lead to osteomyelitis of the spinal column.1,3 A difference has to be made between endogenous and exogenous paths of infection. Endogenous spondylodiscitis is mostly preceded by infection distant from the vertebral bodies. This infection is then spread by the blood. Inflammation usually spreads in the ventral sections of the spinal column. Exogenous spondylodiscitis can be caused by operations or by injections near the spinal column.3 Pathogens causing spondylodiscitis are staphylococci 2,4,5 and mycobacterium tuberculosis.4,9
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.7
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.8
Epidemiology /Etiology[edit | edit source]
According to scarce researches, the incidence of spondylodiscitis is 2.4/100,000 inhabitants. It increases with age. 3,4 Men are up to three times more often affected than women.5,3 Predisposing factors include age, multimorbidity, diabetes mellitus, cardiovascular diseases.3 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 2,4,5 and mycobacterium tuberculosis.4,9
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.3
The symptoms of spondylodiscitis are non-specific.
- Back or neck pain 2,5,6
- 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. 2
- Fever (less commonly) 2,5
- Spinal deformities, predominantly kyphosis and gibbus formation, are commoner in tuberculous spondylitis.2
- Weight loss 2,5
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.3
