Discitis: Difference between revisions

Revision as of 07:39, 19 February 2012

Background

Infection of nucleus pulposus due to infection of vertebral body endplate cartilage
Risk Factors: peds, 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 abx

Disposition

Admit to spine service

Source

Rosen's
Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-Infection of nucleus pulposus due to infection of vertebral body endplates cartilage.
+*Infection of nucleus pulposus due to infection of vertebral body endplate cartilage
-Usually more common in Peds or post-op.
+*Risk Factors: peds, post-op, immunocompromised
-Immunocompromised hosts are at higher risk.
 ==Clinical Features==
-Acute or sub-acute course with pain of affected area. Radicular Sx in 50-90%.
+*>90% p/w unremitting back or neck pain which awakens them at night
-Lumbar spine most common.
+*Fever (60-70%)
-Fever in 90%
+*Neuro deficits (10-50%)
-Pain with Range of Motion
+*ESR elevation (>90%)
-Usually no neurological deficits
+*Leukocytosis (<50%)
-== Work-Up  ==
+== Diagnosis ==
+*Labs
-Plain x-rays to rule out other issues. X-rays are positive after 2-4weeks. In all spine x-rays look for endplate destruction. In C-spine assess pre-vertebral spaces.
+**ESR elevated
+*Imaging
-MRI is diagnostic. CT may show secondary bony abnormalities but not diagnostic for diskitis
+**Plain films are rarely positive
+**MRI is gold standard
-ESR/CRP are high, CBC can be normal.
-Usual pathogens: S. aureus, gram-negatives, fungal, TB.
-[[Image:Diskitis.jpg|thumb|right|381x525px|Diskitis.jpg]]
-<br>
-==DDx==
-Any other neck/back pain DDX
-Rule-out Spinal epidural abscess, malignancy, spinal cord lesions, vertebral artery dissection.
 ==Treatment==
-IV antibiotics
+*IV abx
-Depending if osteomyelitis present may need surgical intervention.
+==Disposition==
+*Admit to spine service
-==Disposition==
-Admission with Spine service (Ortho or Neurosurgery)
 ==Source==
-Marx: Rosen's Emergency Medicine, 7th ed.
+*Rosen's
+*Tintinalli
 [[Category:Ortho]]