Discitis is an uncommon condition involving inflammation of the intervertebral disc space in the spine. This inflammation is most frequently caused by a bacterial or fungal infection that settles in the cushion-like material between the vertebrae. Death from discitis is rare when the condition is identified and treated promptly. With modern medical care, the vast majority of patients recover, though the risk of severe complications and mortality exists, particularly if treatment is delayed.
Understanding Discitis and Risk Factors
Discitis begins as an infection within the intervertebral disc, the space between the bones of the spine. The infection usually spreads through the bloodstream from another site in the body, such as the skin, urinary tract, or lungs. A major challenge in treating this condition is the disc’s limited blood supply. This makes it difficult for the body’s immune cells and circulating antibiotics to reach and neutralize the invading pathogens.
The bacterial species Staphylococcus aureus is the most common organism responsible for infectious discitis. Certain populations face a higher risk of developing this infection due to compromised defenses. Individuals with weakened immune systems, those with chronic conditions like diabetes, and people who use intravenous drugs are particularly susceptible.
Advanced age and recent spinal procedures, such as surgery or injections, also increase a person’s vulnerability to discitis. Discitis in young children is less often linked to a pre-existing condition. The infection causes localized, severe back pain that does not usually radiate down the legs. This pain is often accompanied by a low-grade fever.
How Discitis Can Become Life-Threatening
While the prognosis for discitis is positive with timely treatment, the condition can become life-threatening if the infection is left uncontrolled or progresses rapidly. Mortality rates associated with discitis range widely, averaging between 2% and 20%. The mechanism of fatality is typically due to the spread of the localized infection into the systemic circulation.
The most serious danger is the development of sepsis, which occurs when infectious organisms enter the bloodstream (bacteremia) and trigger a body-wide inflammatory response. This systemic infection can lead to septic shock, causing a dangerous drop in blood pressure and subsequent multiorgan failure. Multiorgan failure is the primary cause of death in severe cases of spondylodiscitis. The risk of death is most pronounced during the initial hospital stay.
Another significant complication is the formation of a spinal epidural abscess. This is a pocket of pus that accumulates in the space surrounding the spinal cord. As the abscess grows, it puts pressure on the spinal cord or the nerve roots, leading to severe neurological deficits, including paralysis. While not directly fatal, this complication can exacerbate systemic infection and requires immediate intervention.
Treatment and Recovery Expectations
Prompt diagnosis is paramount to preventing the severe complications of discitis and involves medical imaging and laboratory tests. Magnetic resonance imaging (MRI) is the preferred method for visualizing the spinal infection. Blood cultures and tissue biopsies help identify the specific pathogen causing the infection. Determining the exact organism is necessary to select the most effective antibiotic regimen.
The standard treatment protocol for infectious discitis is a long course of targeted antibiotics, typically administered intravenously (IV) for several weeks. Patients often receive IV antibiotics for six to eight weeks to ensure the infection is completely eradicated from the disc space. This initial phase may require hospitalization. It is often followed by continued IV therapy at an outpatient infusion center or at home.
Surgery is not always necessary but is reserved for specific circumstances, such as when a large epidural abscess is present and causing neurological impairment. Surgical intervention may also be needed for debridement, which is the removal of infected or damaged tissue. Surgery can also stabilize the spine if the infection has caused significant destruction to the vertebral bones. With successful and timely medical management, most individuals experience a full recovery, although the entire process, including rehabilitation, can take several months.