Vertebral Osteomyelitis/Discitis

23 Dec

submitted by Amit Kumar, M.D.

QUICK HITS:

3 main mechanisms of infection:

  • Hematogenous spread
  • direct inoculation (trauma, spinal surgeries/procedures)
  • contiguous spread from adjacent tissues

 

Culprit:

  • Staph aureus (>50%)
  • enteric gram-neg bacilli (following GU procedures)
  • psuedomonas/candida (often due to IV sepsis or IVDU)
  • group B strep (esp. in diabetics)

Signs & symptoms:

  • Localized spinal pain
  • leukocytosis
  • elevated ESR/CRP
  • fever
  • new radicular symptoms

Diagnostic strategies: Blood culture, MRI (most sensitive radiologic technique), biopsy (open/CT guided)

Differentials: Spinal epidural abscess, psoas abscess, herniated disc, spinal metastasis, vertebral compression fracture

Treatment: Pain control, ANTIBIOTICS (empiric followed by pathogen-directed. Routinely for minimum of 6 weeks), surgery (indications: neuro deficits, abscess needing drainage, cord compression)

Complications:

  • Posterior extension leading to epidural/subdural abscess or meningitis.
  • Anterolateral extension leading to paravertebral/psoas abscess.

***Picture: High signal is T2-weighted MRI at the disc and adjacent vertebral body compatible with diagnosis

Sources:

http://www.uptodate.com/contents/vertebral-osteomyelitis-and-discitis-in-adults?source=search_result&search=discitis&selectedTitle=1~51

http://www.med.harvard.edu/jpnm/tf03_04/jan6/writeup.html

-Picture:http://www.med.harvard.edu/jpnm/tf03_04/jan6/MRI.gif

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