Discitis

Background

• Also spelled as Discitis, and is an infection in the intervertebral disc space but also occurs post surgically in approximately 1-2 percent of patients after spinal surgery.
• Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
• Risk Factors: peds (age < 8yo), post-op, immunocompromised

Clinical Features

• >90% p/w unremitting back or neck pain which awakens them at night
• Fever (60-70%)
• Neuro deficits (10-50%)
• ESR elevation (>90%)
• Leukocytosis (<50%)

Diagnosis

• Labs
  • ESR elevated
• Imaging
  • Plain films are rarely positive
  • MRI is gold standard

Treatment

IV Antibiotics

• Treatment targets S. aureus, Streptococcus, Pseudomonas, E. coli

Inpatient Therapy

• Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
  • Ceftriaxone 2g IV daily
  • Cefepime 2g IV IV three times daily
  • Ceftazidime 2g IV three times daily
  • Ciprofloxacin 400mg IV three times daily

Use cefepime or ciprofloxacin if targeting Pseudomonas spp

Disposition

• Admit to spine service

Source

• Rosen's
• Tintinalli