Discitis

Abstract: Study design Mainly a retrospective study of 101 cases of pyogenic spinal infection, excluding postoperative infections. Data were obtained through medical record review, imaging examination, and patient follow-up evaluation. Summary of background data Hematogenous pyogenic spinal infection has been described variously as spondylodiscitis, discitis, vertebral osteomyelitis, and epidural abscess. Recommended treatment options have included conservative methods (antibiotics and bracing) and surgical intervention. However, a comprehensive classification that would aid in diagnosis, treatment planning, and prognosis has not yet been devised. Objectives To analyze the bacteriology, pathologic entities, complications, and results of treatment options for pyogenic spinal infection. Method All patients received plain radiographs, gadolinium-enhanced magnetic resonance imaging scans, and bone/gallium radionuclide studies. All patients had tissue biopsies. Bacteriology, hematology, and predisposing factors were analyzed. All patients received intravenous and oral antibiotics. A total of 58 patients underwent surgery. Patient outcomes were correlated with clinical status, with treatment method and, where applicable, with location and nature of epidural compression. Statistical analyses were performed. Results Spondylodiscitis occurred most commonly with primary epidural abscess, spondylitis, discitis, and pyogenic facet arthropathy, all occurring rarely. Staphylococcus aureus was the main organism. Infection elsewhere was the most common predisposing factor. Leukocyte counts were elevated in 42.6% of spondylodiscitis cases. The erythrocyte sedimentation rate was elevated in all cases of epidural abscess. There were 35 cases of epidural abscess (frank abscess, 29; granulation tissue, 6). Epidural abscess complicating spondylodiscitis occurred most often in the cervical spine, followed by thoracic and lumbar areas. The rate of paraplegia or paraparesis also was highest in cervical and thoracic regions. There were no cases of quadriplegia. All patients with either epidural granulation tissue or paraparesis recovered completely after surgical decompression. Only 18% of patients with frank epidural abscess and 23% of patients with paralysis recovered completely after surgical decompression. Patients with spondylodiscitis who were treated nonsurgically reported residual back pain more often (64%) than patients treated surgically (26.3%). Conclusions Pyogenic spinal infection can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and epidural abscess. Spondylodiscitis is more prone to develop epidural abscesses in the cervical spine (90%) than the thoracic (33.3%) or lumbar (23.6%) areas. Thecal sac neurocompression has a greater chance of causing neurologic deficit in the thoracic spine (81.8%). Treatment of neurologic deficit caused by epidural abscess is prompt surgical decompression, with or without fusion. Patients with frank abscess had less favorable outcomes than those with granulation tissue, and paraplegia responded to treatment more poorly than paraparesis. Surgery was preferable to nonsurgical treatment for improving back pain.

Abstract: STUDY DESIGN We performed a retrospective review of 48 cases of pyogenic spinal infection presenting over a 12-year period to the National Spinal Injuries Unit (NSIU) of the Republic of Ireland. The NSIU is the tertiary referral center for all adult spinal injuries and diseases of the spine warranting surgical intervention in the Republic of Ireland. OBJECTIVES The objective of this study was to analyze the presentation, etiology, management, and outcome of nontuberculous pyogenic spinal infection in adults. SUMMARY OF BACKGROUND DATA Pyogenic spinal infection encompasses a broad range of clinical entities, including spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. Management of pyogenic spinal infection can involve conservative methods and surgical intervention. METHODS The medical records, radiologic imaging, and bacteriology results of 48 patients with pyogenic vertebral osteomyelitis from 1992 through 2004 were reviewed. The Hospital Inpatient Enquiry (HIPE) System and the NSIU Database were used to identify our study cohort. RESULTS The average age of presentation was 59 years with an even distribution between males and females. Most patients (21 of 48) were symptomatic for between 2 and 6 weeks before presenting to hospital. The most frequently isolated pathogen was Staphylococcus aureus, in 23 of 48 cases (48%); 35 of 48 cases (73%) were managed by conservative measures alone, including antibiotic therapy and spinal bracing. However, in 13 of 48 cases (27%), surgical intervention was required because of neurologic compromise or mechanical instability. CONCLUSIONS In the majority of cases, conservative management of pyogenic spinal infection with antibiotic therapy and spinal bracing is very successful. However, in a minority of cases, surgical intervention is warranted and referral to a specialist center is appropriate.

Abstract: Background. Discitis and vertebral osteomyelitis are uncommon entities, and diagnosis often is confounded by their similar clinical presentation, because characteristic radiographic findings are not evident until late in the course of illness. Objective. To compare the age distribution, clinical manifestations, and radiographic findings, especially magnetic resonance imaging (MRI), in children with discitis or vertebral osteomyelitis. Methods. A retrospective review of 57 children with a discharge diagnosis of discitis or vertebral osteomyelitis hospitalized from January 1980 through December 1998. Results. Fifty patients met inclusion criteria: 36 with discitis and 14 with vertebral osteomyelitis. The mean age at presentation was younger for children with discitis than for those with vertebral osteomyelitis (2.8 vs 7.5 years of age) and the duration of symptoms longer for children with vertebral osteomyelitis than for those with discitis (33 vs 22 days). The initial symptom for both groups of children was refusal to walk, limp, or back pain, but children with osteomyelitis more often were febrile (79% vs 28%) and ill-appearing than those with discitis. Thirty-three patients with discitis had radiographs of the spine; 25 (76%) had abnormalities that were diagnostic. Ten discitis patients had MRI; 9 (90%) had abnormalities consistent with this diagnosis. Thirteen children with vertebral osteomyelitis had radiographs of the spine, but in only 7 (54%) were these abnormal. However, 11 had MRIs, and in each the diagnosis of vertebral osteomyelitis was established. Conclusion. This comparative study suggests that age and clinical presentation distinguish most patients with discitis from those with vertebral osteomyelitis. Although radiographs of the spine usually are sufficient to establish the diagnosis of discitis, MRI is the diagnostic study of choice for pediatric patients with suspected vertebral osteomyelitis.