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Discitis

Richard Holt, M.D.
Orthopaedic Surgeon

and Michael J. Young, M.D.

Defintion of Discitis

Discitis, or disc space infection, is an inflammatory lesion of the intervertebral disc that occurs in adults but more commonly in children. Its cause has been the subject of debate, although most authors believe it to be infectious. The infection probably begins in one of the continguous end plates, and the disc is infected secondarily. Severe back pain that begins insidiously is characteristic of the disease.

 
 

Discitis in Children

Although most children will continue to walk in spite of the pain, young children may refuse to ambulate. The characteristic finding is extension of the spine and the child's complete refusal to flex the spine. Children with discitis usually are not systemically ill. They rarely have an elevated temperature and their white blood cell count is frequently normal. However the erythrocyte sedimentation rate is usually increased. Lateral radiographs of the spine usually will reveal disc space narrowing with erosion of the vertebral end plates of the contiguous vertebrae. bone scanning may be helpful in localizing a lesion that is difficult to diagnose clinically. Some bone scans are falsely negative, so the diagnosis of disc space infection should not be excluded simply because the bone scan is normal. Magnetic resonance imaging (MRI) seems to be helpful in identifying a disc space infection.

The appropriate treatment of these lesions has been the subject of controversy. Most authors recommend plaster cast immobilization, a treatment that seems to be effective by itself in many cases. Some authors think that antibiotics also should be given because the condition most likely is an infection of the disc (the organism involved is frequently Staphylococcus aureus). In treating the lesion in children, a biopsy is not usually necessary. A biopsy may be indicated in adolescents or adults, especially if drug abuse is suspected, because of the possibility of organisms other than Staphylococcus aureus being present.

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Infective discitis

disc infection due to blood-borne bacteria, usually Staphylococcus aureus, or a low grade viral infection. Older children clinically present with back pain, similar to adults. The infective focus is in the thoracic or lumbar spine.

Younger children and infants may present with nonspecific abdominal pain, features of meningism, alteration in posture, or limp. The child may be febrile and ill. Because of this varied clinical presentation the diagnosis may be delayed. Upper respiratory tract infection or diarrhoea may precede the illness. The affected disc is in the lumbar spine. Treatment is bed rest, pain relief and antibiotics, and sometimes immobilization with plaster jacket. Failure to respond should suggest tuberculosis.

Radiologically, there is disc space narrowing, which may progress to end plate destruction. Scintigraphy shows generalised increased uptake in the adjacent vertebral bodies. On MRI, there is increased signal on T2-weighted images and gadolinium enhancement

 
 
 
 
 
   

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05/27/2011

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