Discitis is a spinal infection that can have serious consequences. Severe cases may require surgical treatment and spinal fusion.
Early recognition of your symptoms and immediate treatment will lead to the quickest improvement and the best possible outcome.
It is an infection of the intervertebral disc. It may be a minor infection and cause only mild back or neck pain, or it may cause no pain at all.
More severe cases may advance to a spinal abscess or osteomyelitis. Osteomyelitis is an infection of the bone that is very difficult to eradicate especially in your spine.
In most cases this infection will develop spontaneously and is thought to be seeded by bacteria in your blood. This can occur following dental work or other minor surgery in other areas of your body.
The intervertebral disc has a very poor blood supply. Once an infection is seeded or gets started it is difficult for your body's natural immunity to eliminate it.
Infections can also occur following spinal surgery, but with modern techniques and antibiotics these are not a common occurrence.
MRI image demonstrates Discitis
Image thanks to Hospital for Sick Children in Toronto,
via Wikimedia Commons
The most common symptom of discitis is back or neck pain. When this infection occurs in children they may refuse to stand or walk. Arching of the back is often seen because this posture takes pressure away from the disc and helps to relieve their pain.
Symptoms of infection may also occur such as a high fever or elevated white blood cell count. These are often late signs and do not occur until the infection is severe.
Initial Evaluation may be Negative
These infections can be very difficult to diagnose until it is very advanced. X-rays and MRIs are often negative. Biopsies of the suspected disc can be done, with a needle or by a surgeon, but these are also often negative until late in the disease.
In the Later Stages
In the later stages of discitis x-rays may show bone erosion or other bony changes on x-rays. MRIs will show the infection within the disc sometimes extending into the spinal muscles as an abscess.
Initial treatments for an infected disc may include oral antibiotics but these will often fail and IV antibiotics will be required. Because of the poor blood supply it is difficult for antibiotics to enter the disc and stronger antibiotics are often required.
Some treatment centers will encourage motion and activity to increase the fluid and blood moving in and out of the disc. This is thought to help increase the antibiotic levels within the disc. Bed rest is often discouraged.
May Require Surgery
When patients fail to show improvement with IV antibiotics, or if there is osteomyelitis and bone loss, surgery may be required to remove the infected tissue and stabilize the spine.
If bone loss due to infection is significant there may be a risk of spinal instability and nerve damage. After removing the infected tissue, hardware with rods and screws may be required along with bone grafting to fuse that area of the.