Local examination did not reveal any swelling or tenderness over his spine. May 12, 2012 in april, 2011, an 85yearold man was referred to our hospital with suspected septic spondylodiscitis. Discitis after lumbar epidural corticosteroid injection. Being a self limiting disease, lumbar discitis does not spread and infect the other discs of the spinal column. Not surprisingly, postoperative disc space infections in the lumbar region correspond to the higher ratio of procedures performed on this sector 66 cases compared to the thoracic or cervical spine.
Clinical outcomes of percutaneous plasma disc coagulation. Clinical outcomes of percutaneous plasma disc coagulation therapy for lumbar herniated disc diseases. Pdf surgical management of pyogenic discitis of lumbar region. Additional coronal images may be helpful especially in the setting of scoliosis. We report here a rare case of chronic lumbar discitis caused by clostridium perfringens in an elderly patient that was treated with a combination of. Facet joint osteomyelitis in a patient on longterm. The typical presentation is back pain over 90% of patients and less commonly fever. Similar to the latter cervical condition, even this disease may also afflict children. In the united states, the incidence of discitis is approximately 1 out of every 100,000 people, meaning it is not a common spinal disease. Kutlay m, colak a, simsek h, yildiz s, topuz k, kaya s, cetinkal a, demircan m. This presents when the problem is at the lumbar area of the spinal column. Discitis is usually caused by an infection that develops in one of the spines vertebral bones andor intervertebral discs.
Backache, a common symptom, is rarely caused by infection of the lumbar discs. Discitis is a serious but uncommon medical diagnosis. Thirtyseven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance mr, radiography, and radionuclide studies. Close more info about vertebral osteomyelitis and discitis. Pdf on jan 1, 2020, mohamed adel ghoneim and others.
This is the first report of 2 cases of vertebral osteomyelitisdiscitis caused by enterococcus faecalis in dialysis patients. Mar 25, 2020 lumbar degenerative disc disease is a process that happens to the discs of the spine, usually as people age. Two large prospective series of epidural anaesthesia failed to document a. When an organism is identified, suggested regimens are. The aim of this retrospective study was to com pare the mr features of septic and aseptic post operative discitis in order to determine whether mr imaging could be used as an indicator for the. Narrowing of disk spaces with vertebral endplate involvement on x ray was seen in 74% of the cases. I suspect most of us are familiar with a classic disc herniation that causes sciatica. A man with backache and renal failure american journal of. Management of postoperative spondylodiscitis with and without. I will focus on axial discogenic pain, in which the back pain is primary. The authors postulate that the maneuver is a protective mechanism performed to.
Jul 05, 2017 before deciphering the abnormalities listed in the lumbar mri report, its important to understand the normal anatomy. The vertebral bodies are usually labeled 1 through 5, and the discs are named by the bones above and. Treatment with antibiotics and not immunosuppressive agents resulted in improved renal function with a discharge. Pain emanating from the lumbar disks most commonly affects the low back, buttocks, and hips and may result from progressive damage to the annular fibers, particularly the pain fibers that reside in the outer third of the annulus 5.
The diagnosis and management of these two entities are similar in most patients. Discitis occurs postsurgically in approximately 12 percent of patients. If a spinal implant is infected, add rifampin 300 mg po q12 hours to regimen. Predicting patients with concurrent noncontiguous spinal epidural abscess lesions.
Discitis in the cervical region presents with severe neck pain. Osteomyelitis is a common condition wherein it affects the bones through inflammatory process. We describe the case of an unfortunate man whose osteomyelitis was located in the posterior facet joints. His medical history included chronic back pain because of advanced spinal degeneration, chronic renal insufficiency, and gouty arthritis.
In adults, it can lead to severe consequences, such as sepsis or epidural abscess, but it can also spontaneously resolve, especially in children under 8 years of age. Standard surgical management of spontaneous spinal infection is based on debridement of the infected. Mar 01, 2009 characteristic mr imaging features of brucellar spondylitis include a predilection for the lower lumbar spine, intact vertebral architecture despite evidence of diffuse vertebral osteomyelitis, fig 3, a marked increase in signal intensity in the intervertebral disk on t2weighted and contrastenhanced mr images, and facet joint involvement. Discitis is one of several kinds of spinal inflammation. The authors present the case of a 60yearold man with a staphylococcus aureus septicemia and associated lumbar discitis in whom a pauci immune crescentic glomerulonephritis and renal failure developed. Department of orthopaedic surgery, fukushima medical university school of medicine, fukushima, japan. Spinal osteomyelitis is a recognized complication in dialysis patients related to hematogenous spread of infection during bacteremiasepticemia. Research conducted at the adelaide centre for spinal research. These episodes are often associated with sepsis due to temporary dialysis access. Pure brucellar discitis mimicking lumbar disc herniation. Direct spread may occur from discitis or vertebral osteomyelitis. Epidural steroid injections for acute lumbar disk herniation may modestly improve pain in the shortterm, but do not impact longterm outcomes.
Septic and aseptic postoperative discitis in the lumbar. Enterococci spreading hematogenously to the spine is a rare phenomenon, with very few cases identified to date. Discitis, or diskitis, is an infection in the intervertebral disc space that affects different age groups. Spinal discitis and spondylodiscitis in older people find, read and cite all the. Vertebral osteomyelitis and discitis may occur together or independently. Click on any term below to browse the alphabetical index. Lumbar discitis is also referred to as lumbar disk diseases. The lumbar segment was the most affected with 11 cases 52%, followed by thoracolumbar in 24%. Posterior fixation without debridement for vertebral body. Spondylodiskitis, also referred to as diskitisosteomyelitis, is characterized by infection involving the intervertebral disc and adjacent vertebrae. Discitis symptoms, causes, diagnosis and treatment.
Discitis definition of discitis by medical dictionary. Discitis, failed spinal surgery, conservative and surgical management. The lumbar region was the most commonly involved site 48%. Role of surgery in management of discitis the egyptian journal of. When the lumbar region is affected, there is pronounced low back pain. We report a retrospective analysis of a series of patients. The established protocols of treatment of postoperative lumbar discitis have not been validated till date. Report of 2 cases of vertebral osteomyelitisdiscitis caused. Postoperative discitis following singlelevel lumbar discectomy. Nov 21, 2018 diskitis is an inflammation of the vertebral disk space often related to infection. Molecular analysis performed on the strain revealed an unusual toxin gene pattern. The thoracolumbar junction and the lumbar spine are most often affected, and one or more vertebral segments may be involved. Gowers sign in children with discitis of the lumbar spine.
Thus the discitis is selflimiting or does not infect other disc. The lumbar spine consists of bones usually five vertebral bodies stacked on top of each other and separated by five discs. Corresponding view 2 months after operation of the third interspace. The clinical manifestation and radiologic appearance of spinal neuropathic arthropathy may resemble those of severe degenerative disease, spinal infection, or metastatic disease, 40. Pdf postoperative lumbar discitis gianluca cinotti. Spondylodiskitis has a bimodal age distribution, which many authors consider essentially as separate entities. The term pyogenic spondylitis refers to either vertebral osteomyelitis or discitis. Discogenic pain diagnosis and treatment by marc heller, dc this is the first of three articles on lumbar discogenic pain. Radiopaedia is a rapidly growing openedit educational radiology resource which has been primarily compiled by radiologists and radiology trainees from across the world. Enterococci are a major cause of bacteremia and infective endocarditis. Discitis treatment, symptoms, pictures, diagnosis, causes.
Pdf pure brucellar discitis mimicking lumbar disc herniation. It is severe and tenderness may be noted by pressing over the affected area. Vertebral osteomyelitis and discitis cancer therapy advisor. Discitis, or disc space infection, is an inflammatory lesion of the intervertebral disc that occurs in adults but more commonly in children. Infection of the disk space must be considered with vertebral osteomyelitis, as these conditions are almost always present together and share much of the same pathophysiology, symptoms, and treatment. Pdf surgical management of pyogenic discitis of lumbar. Although degenerative disc disease can occur at any place along the spine, it is most often seen in the lumbar region. Frontal and lateral radiographs of the thoracic spine demonstrate destruction of the endplates of two contiguous vertebral bodies with considerable endplate sclerosis, findings characteristic of discitis. Discitis is a spinal disc infection and inflammation.
Lumbar discitis is a condition which occurs due to problems in the lumbar region present in the spinal column. Your spines surrounding tissues, joints, and vertebrae can also become irritated and inflamed. Its cause has been the subject of debate, although most authors believe it to be infectious. His systemic and neurological examinations were normal. Osteomyelitis discitis is inflammation of the bones. Our mission is to create the best radiology reference, and to make it available for free, forever. Surprisingly, patients 33% received empiric antibiotics secondary to fever and spine pain without a confirmatory diagnosis of spinal infection. The code is valid for the year 2020 for the submission of hipaacovered transactions. Epidural infection is a recognized complication of epidural anaesthesia2,912 and lumbar puncture4, but must be extremely rare in relation to the number of epidural anaesthetics given9,14. The discs along the spine are soft and compress easily to protect the vertebrae and absorb shock. Find, read and cite all the research you need on researchgate.
The standard spine mri protocol includes imaging in the sagittal and axial planes using t1 and t2weighted sequences figures 141 and 142. Basu, 17 cases of postoperative discitis were treated with rest. To analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region. Septic and aseptic postoperative discitis in the lumbar spine. Acute pseudogout lumbar discitis resembling acute pyelonephritis in an elderly woman. Magnetic resonance mr imaging is a powerful diagnostic tool that can be used to help evaluate spinal infection and to help distinguish between. Learning radiology discitis, osteomyelitis, spine, disc, disk. In the adult population, vertebral discitis and osteo. Discitis is not an uncommon condition and can be potentially life threatening if diagnosed late. Dislocation of oth prt lumbar spine and pelvis, init encntr. Often, discitis is a bacterial infection, but it may be viral. Surgical management of pyogenic discitis of lumbar region. Lumbar intervertebral disc infection adelaide research.
A 9 month old, previously healthy boy presented with low grade pyrexia, refusal to sit or stand, and increased irritability. Discitisosteomyelitis ghaffari a, lanier l, sistrom c, slater r, shah j, rajderkar d, mancuso a, schmalfuss i university of florida, gainesville, fl the authors have no financial relationships to disclose for this educational activity. Medical management of spinal discitis and vertebral osteomyelitis is based on pathogen specific antibiotic therapy. Antibiotic and hyperbaric oxygen therapy in the management of postoperative discitis. This is another form of discitis which may be determined by pain in the lower back. The infection probably begins in one of the continguous end plates, and the disc is infected secondarily.184 618 1455 802 1485 1323 1260 460 817 1270 1497 1007 484 1523 147 1561 1440 1357 191 1042 36 739 118 579 751 1567 520 1368 767 1336 1202 757 1144 1299 1500 1540 1265 208 1358 958 1205 1366 555 497 14 1086 1080