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A 29-year-old male presented with a two month history of intermittent low back pain following a febrile illness. Two planar bone scans performed with Tc-99m MDP were normal despite roentgenographic and SPECT scintigraphic evidence of discitis. This case demonstrates the increased sensitivity of SPECT in the diagnosis of discitis.
Thirty-nine children with suspected pathology involving the vertebral column were investigated haematologically, radiographically, and by bone scintigraphy using technetium 99M pyrophosphate. Fifteen children were shown to have inflammatory disease of the vertebrae. A further six suffered from Scheuermann's disease, two from benign tumours, and the remainder from miscellaneous diseases not specifically involving bony pathology. The nuclide scan was abnormal in all cases of discitis and osteomyelitis, and in the two tumours. All of the other conditions were associated with a normal bone scan. This finding is of considerable diagnostic importance, and leads support to the theory that discitis is due to bacterial infection.
Over a period of three years four girls and two boys presented with discitis. All were less than 5 years old at presentation, and each had a short history of symptoms. Three were initially thought to have pathological defects of the abdomen. All children showed abnormal posturing with exaggerated lumbar lordosis. Diagnosis was essentially clinical. All cultures were sterile. The erythrocyte sedimentation rate was increased in all the children and all had mild pyrexia. Symptoms lasted from two to 8 weeks. Discitis should be considered in any child with fever, abnormal posturing, and refusal to walk. Early recognition may avoid unnecessary diagnostic and treatment procedures.
Three cases of discitis in early childhood presented with acute refusal to walk or change in gait pattern without neurologic deficits. In all three, a Gowers' sign was observed, although none had muscular weakness. The diagnosis of discitis was confirmed by the characteristic radiographic findings on survey lumbosacral films and/or by a hot spot at the L3 level on technetium bone scan.
The clinical and laboratory findings in 15 patients with septic discitis are reported. The clinical picture was that of a sub-acute illness characterized by back pain, spinous process tenderness, and sciatic nerve root irritation. There was a considerable delay from clinical presentation to diagnosis (average 14 wk). The erythrocyte sedimentation rate was the most useful diagnostic laboratory blood test and the best indicator of disease activity. The relative value of plain radiographs, tomography, and radionuclide bone scans is discussed. Needle aspiration of the disc space was found to be a useful diagnostic test. We found that a diagnosis of septic discitis could be made even in the absence of positive bacterial cultures from various biologic fluids or from the disc space. Long-term oral and intravenous antibiotic therapy with controlled rest resulted in a favourable outcome.
Twelve children with lumbar discitis were reviewed. The average age at diagnosis was 2.5 years. Seven were girls, and the follow-up varied between 2 and 10 years (average 5 years). The clinical signs were general irritability, abdominal or hip pain and refusal to walk or to sit. The erythrosedimentation rate was elevated in all but two. Radiographic narrowing of the disc space was seen in seven patients. Needle disc aspiration was done in five cases with two being positive for Staphylococcus aureus. Blood culture was positive in one case. Magnetic resonance imaging helped to diagnose the condition in three. Treatment consisted of bed rest and immobilisation of the spine; intravenous antibiotics were given to nine children. The natural course of the disease was benign in all our twelve cases.
The few reported cases of bone and joint infection by Staphylococcus lugdunensis indicate that the clinical manifestations are severe, the diagnosis elusive, and the treatment difficult. We report a case of lumbar discitis caused by Staphylococcus lugdunensis in a 67-year-old man receiving chemotherapy for stage III IgA lambda multiple myeloma. Treatment was with ofloxacin and pristinamycin for 1 year. Although he started to improve only 5 months after treatment initiation, the outcome was favorable. Follow-up at the time of this writing is 3 years.
This study reported on the anamnesis, clinical and instrumental findings as well as therapy in a girl with discitis. The described diagnostic problems and course are characteristic of this frequently unrecognized disease, the cause of which has not yet been fully clarified. Diagnostic and therapeutic procedures suggested in the literature were critically evaluated.
This study demonstrates that infection of the retro- and intradiscal space is probable, when the temperature rises above over 37 degrees and CRP exceeds 2.0 mcg/ml 5 days postoperatively. MRI of 4 patients confirmed a retrodiscal infection that was indicated by a hyperintense band shaped structure in PS-sequences and which was space occupying with respect to the dural sac. Discitis was demonstrated by intradiscal hyperintensity in STIR images and by enhancement in T1 weighted images following the application of Gadolinium DTPHA. Diagnosis is simplified by comparison of pre- and postoperative MR-examination. Infection can be cured by treatment with antibiotics (Tobramycin and Clindamycin) bedrest and plaster cast.
The incidence of postoperative discitis in a series of almost 7500 surgical interventions covering a period of 15 years is reported. Ninety patients (1.2%) were found to be suffering from typical symptoms, which are described and discussed. It is pointed out that above all radicular pain diminished, while on the other hand severe pain occurred in the lumbar spine, caused by movement and vibration, accompanied by a usually sharp rise in ESR, up to values of 100/200 mm. It is pointed out that conventional tomography is the diagnostic tool of choice, diagnosis being possible as of approx. three weeks postoperatively. The social implications of this important complication are pointed out, in particular the fact that only 50% of patients were able to return to full-time work in their old occupations, while the rest had to retire or accept a less strenuous job.
Many paediatricians are unaware of the disease entity of discitis, which must be included in the differential diagnosis of several acute and subacute diseases of infancy and childhood. In order to draw attention to this disorder, three Swedish and two Arabic children, aged from 9 months to 3 years, are jointly presented. The onset of symptoms was 2-4 weeks prior to admission. The clinical diagnosis was verified by plain X-ray of the spine and bone scanning. Two of the children had low grade fevers. The erythrocyte sedimentation rates were moderately elevated, while white blood cell counts were normal or slightly increased. Blood cultures were negative. The children were treated with immobilization, and three of them received antibiotics. Full recovery was achieved in all children after 1-2 months. The diagnostic procedure and the rationale of using or not using antibiotic treatment is discussed.
A 63-year-old man presented with spinal cord compression caused by rheumatoid discitis at a high thoracic level. Nuclear magnetic resonance imaging proved to be very useful in evaluating the extent of the inflammatory process. Early decompression and internal fixation resulted in cure with only some residual functional impairment.
We report a case of secondary psoas abscess in a 37-year-old man with a 3-week history of severe low backache managed conservatively without surgical drainage. Apart from bilaterally restricted straight leg raising (<70 degrees), his neurologic examination was within normal limits. Magnetic resonance imaging showed discitis of the L3-L4 space and a left-sided secondary psoas abscess. Aspiration biopsy of the abscess material under radiologic control isolated Staphylococcus aureus, which responded to appropriate antibiotic therapy with complete resolution. A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in patients with pyrexia and backache with a neurologic examination that is otherwise normal. We discuss the recommendations for surgical and nonsurgical approaches.
An unusual case of discitis in a 60-year-old, insulin-dependent, diabetic man is presented. Radiographs of the lumbar spine demonstrated changes associated with infection of the intervertebral disc space. Cultures from the L5-S1 disc space grew the microorganism designated by the Centers for Disease Control as Group Ve-1, an organism that has had questionable clinical significance in the past, and has not been reported as a pathogen in an intervertebral disc space.
METHODS. Percutaneous discectomy was successfully used to diagnose and treat bacterial discitis. CONCLUSIONS. This technique was successful in obtaining a bacteriologic diagnosis, relieving the patient's symptoms and assisting in the eradication of the infection. With percutaneous discectomy, there is lower morbidity and cost than with open treatment. Any comments on the overall effectiveness of this technique will need to be based on additional cases.
STUDY DESIGN: Aspergillus osteomyelitis of the vertebral body and disc space is rare. This report discusses a case that occurred in an immunosuppressed 29-year-old man and reviews the pertinent medical literature. OBJECTIVES: To review the management and treatment of Aspergillus osteomyelitis of the vertebral body and disc space. SUMMARY OF BACKGROUND DATA: The patient presented with acute neurologic compromise resulting from L5-S1 discitis and a large epidural soft tissue component secondary to the Aspergillus infection. RESULTS: The patient underwent aggressive surgical debridement along with treatment with amphotericin B and had a complete clinical recovery. CONCLUSIONS: The authors recommend a combined medical-surgical approach in most cases of vertebral Aspergillus osteomyelitis. Early surgery with vigorous surgical debridement along with antifungal treatment seems to yield a good outcome.
Pseudomonas pickettii, a nonfermenting, gram-negative rod, is rarely pathogenic. Previous reports of infection with P. pickettii have largely involved direct contamination of supplies presumed to be sterile. We describe a case of vertebral osteomyelitis and intervertebral discitis caused by P. pickettii in a debilitated patient. The aggressive nature of this infection demonstrates that P. pickettii may be a more invasive organism than previously noted, particularly in hosts with weakened immunity secondary to underlying disease.
We describe the first known case of vertebral osteomyelitis and discitis caused by Blastoschizomyces capitatus in a leukemic patient and the results of therapy. We also reconfirm the microbiological characteristics which differentiate this species from other yeastlike pathogens.