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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.
A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin's lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of intravenous narcotic analgesia. Magnetic resonance imaging of the spine was highly suggestive of disk infection. Fluoroscopically guided needle aspiration of the disk space was confirmatory, and both tissue and blood cultures were positive for coagulase-negative Staphylococcus species. Treatment included i.v. vancomycin and oral levofloxacin. The most common organism causing disk space infection is Staphylococcus aureus. but Staphylococcus epidermis should be considered in immunocompromised patients. Septic discitis is an important differential diagnosis of back pain and should be considered in any clinical situation associated with bacteremia.
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.
A case of thoracic discitis secondary to a pyodermal skin condition known as 'Woodbury' rash is described.
Discitis is uncommon in children and presents in different ways at different ages. It is most difficult to diagnose in the uncommunicative toddler of one to three years of age. We present 11 consecutive cases. The non-specific clinical features included refusal to walk (63%), back pain (27%), inability to flex the lower back (50%) and a loss of lumbar lordosis (40%). Laboratory tests were unhelpful and cultures of blood and disc tissue were negative. MRI reduces the diagnostic delay and may help to avoid the requirement for a biopsy. In 75% of cases it demonstrated a paravertebral inflammatory mass, which helped to determine the duration of the oral therapy given after initial intravenous antibiotics. At a mean follow-up of 21 months (10 to 40), all the spines were mobile and the patients free from pain. Radiological fusion occurred in 20% and was predictable after two years. At follow-up, MRI showed variable appearances: changes in the vertebral body usually resolved at 24 months and recovery of the disc was seen after 34 months.
The authors report the study of eight children with discitis diagnosed through clinical, neurological and orthopedic evaluation. The evidence of self limiting inflammation or infection of the intervertebral disk space and of soft tissue were available by image studies. Findings with routine roentgenograms, computed tomography and magnetic resonance imaging are discussed.
An unusual case of discitis and vertebral osteomyelitis due to Haemophilus aphrophilus is described. Infections due to this organism have usually responded to treatment with beta-lactam antibiotics. However, our isolate was resistant to third-generation cephalosporins which has not been reported previously in the world literature. The patient made a good clinical response to ciprofloxacin treatment.
We report a follow-up of 35 children, on average 17 years after they had intervertebral discitis. 15 patients still complained of backache. Flexion of the low back was normal in 32 patients, while extension was markedly restricted in 30. 26 patients had a block vertebra, and 28 patients had narrowing of the vertebral canal. Mode of treatment did not appear to affect the outcome.
OBJECT: Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. METHODS: A retrospective analysis of 17 consecutive patients with PDVO treated between July 1996 and September 1999 was performed. Follow-up data (mean 30 months) included office examinations and telephone interviews, and patients were grouped according to the duration of preoperative antibiotic therapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were independently ambulatory, and three required a walker; only five had been ambulating independently preoperatively. Two patients died during the 1st postoperative week of medical complications; another developed a wound dehiscence that was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonstrated on dynamic radiography. Most patients received only a 6-week course of intravenous antibiotics postoperatively. CONCLUSIONS: The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.