Discitis: Difference between revisions

(Text replacement - "==References== " to "==References== <references/> ")
 
(2 intermediate revisions by 2 users not shown)
Line 1: Line 1:
==Background==
==Background==
*Infection in the intervertebral disc space
*Infection in the intervertebral disc space
**occurs post surgically in approximately 1-2 percent of patients after spinal surgery.
**occurs post surgically in approximately 1-2% of patients after spinal surgery.
*Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage  
*Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage  
*Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised
*Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised
Line 7: Line 7:
==Clinical Features==
==Clinical Features==
*>90% present with unremitting neck or [[back pain]] which awakens them at night
*>90% present with unremitting neck or [[back pain]] which awakens them at night
**May have radicular symptoms
*Fever (60-70%)
*Fever (60-70%)
*Neuro deficits (10-50%)
*Neuro deficits (10-50%)
Line 13: Line 14:


==Differential Diagnosis==
==Differential Diagnosis==
[[File:Pinfecteddisc.png|thumb|CT of an infected disc at the level of C5-C6 causing neurological symptoms]]
[[File:Discitis.jpg|thumb|MRI of discitis in a 2 year old child.]]
{{Spinal infection types}}
{{Spinal infection types}}


Line 18: Line 21:


==Evaluation==
==Evaluation==
[[File:Pinfecteddisc.png|thumb|CT of an infected disc at the level of C5-C6 causing neurological symptoms]]
 
[[File:Discitis.jpg|thumb|MRI of discitis in a 2 year old child.]]
*Labs
*Labs
**ESR elevated
**ESR elevated

Latest revision as of 15:01, 4 January 2021

Background

  • Infection in the intervertebral disc space
    • occurs post surgically in approximately 1-2% of patients after spinal surgery.
  • Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
  • Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised

Clinical Features

  • >90% present with unremitting neck or back pain which awakens them at night
    • May have radicular symptoms
  • Fever (60-70%)
  • Neuro deficits (10-50%)
  • ESR elevation (>90%)
  • Leukocytosis (<50%)

Differential Diagnosis

CT of an infected disc at the level of C5-C6 causing neurological symptoms
MRI of discitis in a 2 year old child.

Spinal infection

Lower Back Pain

Evaluation

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

Management

IV Antibiotics

Inpatient Therapy

Use cefepime or ciprofloxacin if targeting Pseudomonas spp

Disposition

  • Admit

References