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Discitis - Causes, Symptoms, Diagnosis, and Treatment

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Discitis - Causes, Symptoms, Diagnosis, and Treatment

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Discitis is an infection and inflammation of the intervertebral discs causing severe pain. The below article describes the discitis condition in detail.

Written by

Dr. Deepiha. D

Medically reviewed by

Dr. Mrinal Prakash

Published At August 10, 2022
Reviewed AtFebruary 20, 2023

Introduction:

An intervertebral disc, simply known as the disc, is a type of connective tissue that supports the vertebral column (backbone). They are present in between each vertebra and hold them together. The primary function of the intervertebral disc is to act as a shock absorber for the spine and also allow limited movement of the backbone. In plain X-ray images, the intervertebral disc shows as a black space between the two opaque-white vertebrae, which is known as the intervertebral disc space.

What Is Discitis?

Discitis is an infection of the intervertebral disc space. It is a rare but serious condition that can lead to fatal consequences.

The incidence of discitis is more common in children and people aged 50 and above, thus having a bimodal distribution. Males are more frequently affected than females. An individual can have peak and down of discitis several times in their lifetime. The lower backbones are commonly affected, followed by the neck bone and the upper backbone.

What Are the Causes of Discitis?

Discitis is most commonly caused by the bacteria, Staphylococcus aureus. Other organisms associated are Escherichia coli, Streptococcus pneumoniae, and salmonella species. Sometimes, fungi can also be involved, and it is usually due to Candida albicans but may involve other candida or Aspergillus species. Mycobacterium tuberculosis can also be considered the cause, especially in immunocompromised individuals.

The infection of the intervertebral space can arise from three routes as follows,

  • Direct Infection: Surgery or trauma can directly inoculate the pathogen in the disc space.

  • Through Blood: Urinary tract infections, lung infections, and other soft tissue infections from the bacteria can spread through blood and affect the vertebrae first, followed by the disc space. It is the common route of spread in most patients.

  • Spread From Nearby Structures: Localized infection from the neighboring parts caused by surgery, injection, or puncture can reach the disc space.

Some of the risk factors associated with discitis are,

  • Presence of infectious bacteria in the bloodstream.

  • Spinal surgeries involving catheters.

  • Patients who are receiving dialysis.

  • Infection in the adjacent area.

  • Frequent usage of drug injection.

  • Older age.

  • Malnutrition.

  • AIDS (acquired immunodeficiency syndrome)

  • Chronic steroid usage.

  • Immunocompromised condition.

  • Alcohol dependence.

  • Presence of cancer.

  • Liver dysfunction.

  • Kidney failure.

  • Diabetes mellitus.

What Are the Signs and Symptoms of Discitis?

When the infection leads to inflammation of the intervertebral disc space, patients may complain of:

  • Severe back pain and neck pain.

  • Inability to move.

  • Fever.

  • Eating disorder and loss of weight.

  • Muscle spasm and weakness.

  • Bowel and bladder dysfunction.

  • Neurologic problems.

  • Abnormal spine curvature in children, and they may refuse to walk.

Unresolved infection may lead to:

  • Infection and inflammation of the vertebral column.

  • Fusion of the vertebrae.

  • Bone infection.

  • Pus formation.

  • Spinal deformity and paralysis.

How to Diagnose Discitis?

Medical History and Physical Examination:

Physicians may interrogate details about the recent surgery and debilitating diseases like diabetes mellitus for early diagnosis of discitis. They may also palpate the area of infection to check for tenderness and range of motion. Neurologic examination may be necessary for a few patients. Other systemic examinations may be required to locate the source of infection.

Blood Test:

The blood is investigated for ESR (erythrocyte sedimentation rate - high in reduced function of red blood cells) and CRP (C-reactive protein - a circulating protein that becomes high in inflammatory changes of the body). The ESR and CRP are often raised in discitis, and both the parameters are used to assess the outcome of the treatment. Blood cultures are evaluated to identify the causative pathogen and to guide specific antibiotic treatment.

Imaging Techniques:

  • X-Rays: The overall alignment and stability of the vertebral column can be assessed using plain radiographs. In addition, they play an important role in comparing pre and post-treatment variation and are documented for follow-ups.

  • CT (Computed Tomography) Scan: The CT images provide finer details of the structure, and any minor abnormalities in the spinal column can be detected much earlier. The pattern of destruction in the bone scattered bony fragments, and the calcifications within the intervertebral disc space are apparent in CT images that can be helpful before surgical planning.

  • Image-Guided Biopsies: It is a minimally invasive method that uses real-time images for getting sampling tissues and can be performed using CT scanning.

  • MRI (Magnetic Resonance Imaging): In the case of discitis, MRI is the most specific and sensitive modality in diagnosing radiological changes. The exact extent and location of the infection can be measured. MRI is useful in demonstrating the structural change and local features of inflammation that helps to characterize pus-forming infections, abnormal growth of cells, and spinal tuberculosis. Paraspinal muscles and spinal canal involvement can also be identified.

  • Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI): It will improve the image illustration and provide accurate diagnostic information.

  • Bone Scintigraphy: It is a specialized radiological procedure that is otherwise known as a bone scan. Small amounts of radioactive material and a tiny camera are used to detect bone activity. In discitis, bone scans are used to rule out metastatic lesions (cancer that has spread from a distant part of the body).

Biopsy:

A piece or sample of the inflamed tissue can be removed and evaluated under a microscope to confirm the diagnosis of discitis.

How to Treat Discitis?

  • Broad-spectrum antibiotics are preferred until the culture reports arrive. Initially, it is essential for Staphylococcus coverage.

  • Specific drugs for the particular pathogen should be administered once the culture report is evaluated.

  • Painkillers (NSAIDs - non-steroidal anti-inflammatory drugs) are used to alleviate the symptoms.

  • Bed rest and bracing (supporting device) to immobilize the vertebral column.

  • Finally, surgical debridement is needed to remove the damaged tissue and prevent the infection from spreading to the neighboring areas.

  • It is also important to prevent and treat infections in other parts of the body before they spread to the disk space.

Conclusion:

Although discitis is a rare disease that can sometimes resolve on its own, there are always risky consequences associated with it. Treatment planning is also difficult because of the scarce supply of blood to the intervertebral disc. The treatment outcome is better in children compared to adults. Early diagnosis and management are ideal for getting the best treatment results. If left untreated, it may lead to some permanent deformity of the spine and the nervous system.

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Dr. Mrinal Prakash
Dr. Mrinal Prakash

Orthopedician and Traumatology

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