Discitis osteomyelitis is a rare but serious infection targeting the spine. It involves the intervertebral discs and adjacent vertebrae. Untreated, it can lead to severe pain, discomfort, and complications.
Understanding Discitis Osteomyelitis
Discitis osteomyelitis is an infection of the intervertebral discs and vertebral bones. The intervertebral discs are soft, gel-like pads between the vertebrae, providing cushioning and flexibility. As the infection progresses, it causes inflammation and bone destruction.
The infection typically starts in the vertebral endplate, the bone surface adjacent to the disc, then spreads into the disc space and neighboring vertebral body. While bacterial infections are most common, fungal infections can also cause it. This condition affects all ages, though it presents differently in children compared to adults.
Causes and Risk Factors
The infection typically reaches the spine via the bloodstream from infections elsewhere in the body. Common sources include urinary tract infections, skin infections, or pneumonia. Less commonly, discitis osteomyelitis can result from direct spread after spinal surgery or direct trauma.
Several factors increase susceptibility to this spinal infection. Age is a factor, with young children and older adults being more vulnerable. Individuals with weakened immune systems from conditions such as diabetes, HIV/AIDS, or chemotherapy also face a higher risk. Intravenous drug use is another risk factor, introducing bacteria directly into the bloodstream.
Recognizing the Signs
Recognizing discitis osteomyelitis is challenging as symptoms are often non-specific and mimic other conditions. For adults, a primary indicator is severe, persistent back pain localized to the infected area, which may not improve with rest or standard pain relievers. This pain can worsen with movement or pressure on the spine.
Other symptoms include fever, chills, and back stiffness. In children, symptoms might be more subtle, including unexplained fever, irritability, refusal to walk, or limping. Diagnosis is often delayed due to the general nature of these symptoms, making medical evaluation important when persistent back pain accompanies signs of infection.
Diagnosis and Treatment
Diagnosis typically involves physical examination and medical history review. Blood tests are important, often revealing elevated inflammation markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), though white blood cell counts may not always be high. Identifying the specific pathogen is crucial, often requiring blood cultures or a biopsy of the infected disc or bone.
Imaging studies are essential for diagnosis, with Magnetic Resonance Imaging (MRI) particularly effective for detecting early infection and complications like abscesses due to its high sensitivity. X-rays and CT scans may also be used, though they might not show changes until the infection has progressed. Treatment primarily involves long courses of antibiotics, initially administered intravenously for several weeks, followed by oral antibiotics. Pain management and immobilization with bracing may also be recommended for healing. Surgical intervention, though less common, may be necessary for significant bone destruction, abscess formation, or neurological deficits.