Diagnosis
Discitis
An inflammation of the intervertebral disk space often related to infection.
Also known as: Infectious discitis, Infectious spondylodiscitis, Pyogenic discitis, Pyogenic Spondylodiscitis, Spondylodiscitis, Vertebral osteomyelitis
Etiology
Cause [won] [fma]
Postoperative (28%)
Spinal surgery
Lumbar puncture
Spontaneous/hematogenous spread (72%)
Urinary tract (30.8%)
Infection at a vascular access site (7.7%)
Immunodeficiency (6.4%)
Intestinal infection (5.1%)
Endocarditis (5.1%)
Sepsis after prostatic biopsy (2.6%)
Pneumonia [fma]
Osteomyelitis
Not identified (42%)
Microbe: [won][fma]
S.aureus
M.tuberculosis
Streptococcus
Enterococcus
Gram negative bacilli, Escherichia coli
A-hemolytic streptococcus, streptococcus pneumoniae, and Kingella kingae
C.albicans, Brucella, P.aeruginosa
Pathophysiology [won][fma]
The intervertebral discs separate and cushion the spinal segments from each other
Systemic infection/bacteremia --> Septic emboli enter the metaphyseal arteries
Spreads through the vertebral body and into the poorly vascularized disk space
Infection in an area of low antibiotic penetration (due to scarce blood supply)
Infection can spread to the epidural space
Risk factors [1kv]
Old age
Previous spine surgery
Distant infectious focus
Diabetes mellitus
Intravenous drug use
HIV
Immunosuppression
Oncologic history
Renal failure
Complications [fma]
Spinal deformity
Epidural infection
Epidemiology
Incidence per 100.000 [won][m6y][n8b][wfb]
Symptoms & findings
Symptoms
Anorexia, Chills, Confusion, Fever, Lethargy, Muscle weakness, Nausea, Paresis, Paresthesia, Vomiting, Weight loss
Clinical findings
Elevated CRP, Elevated Sedimentation Rate, Leukocytosis
Anamneses
None listed.
Localized findings
Approach
Blood test
Blood culture
MR columna: bone marrow edema, reduction in disc height, spinal cord changes and/or paravertebral collections
Percutaneous discovertebral biopsy
Treatment
Antibiotic therapy [fma]
immediate broad-spectrum antibiotics to awaiting cultures for sensitivity
Immobilisation: stabilization of the spine --> reduction of pain and prevents deformity
Bed rest
Spinal brace or corset
Surgery: [coh][3zk]
Drainage of the abscess
Removal of the infected tissue --> debridement
Compression of the cord or cauda equina --> Urgent surgical decompression
Stabilization of the spine:
Anterior arthrodesis with autograft, allograft, titanium mesh cage
Posterior fixation
Differential diagnoses
Ankylosing spondylitis, Compression fracture, Epidural hematoma, Osteomyelitis, Rheumatoid spondylitis, Spinal cord infection, Spinal cord tumor, Spinal disc herniation, Subdural empyema, Tuberculosis
References
[1] Cebrián Parra JL, Saez-Arenillas Martín A, Urda Martínez-Aedo AL, Soler Ivañez I, Agreda E, Lopez-Duran Stern L. Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital. Int Orthop. 2012 Feb;36(2):239-44.
[2] Muscara JD, Blazar E. Diskitis. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541047/
[3] Naveen Pandita, Paul, S., Yadav, G., Roop Bhushan Kalia and Pankaj Kandwal (2019). Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center. Asian spine journal, 13(4), pp.621–629.
[4] Grammatico L, Baron S, Rusch E, Lepage B, Surer N, Desenclos JC, Besnier JM. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect. 2008 May;136(5):653-60.
[5] Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect. 2014 Apr;68(4):313-20.
[6] Katzouraki G, Vasiliadis ES, Marougklianis V, Evangelopoulos DS, Pneumaticos SG. A Systematic Review of the Diagnosis and Treatment of Non-Typhoid Salmonella Spondylodiscitis in Immunocompetent Children. Children (Basel). 2022 Nov 29;9(12):1852.
[7] Herrero CFP da S, Nascimento AL do, Cunha RP, Souza JPV de, Nogueira-Barbosa MH, Defino HLA. Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes? Coluna/Columna. 2014 Dec;13(4):294–7.
[8] Kwon, J.-W., Hyun, S.-J., Han, S.-H., Kim, K.-J. and Jahng, T.-A. (2017). Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment. Korean Journal of Spine, [online] 14(2), pp.27–34.
[9] http://emedicine.medscape.com/article/1263845 (2014-01-02); [Medscape]
[10] [http://www.uptodate.com]
[11] Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis : clinical, microbiological and radiological features. QJM Monthly Journal of the Association of Physicians 2001 ; 94 : 465–470.
[12] Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweden : a retrospective study of patients during 1990–95. Scandinavian Journal of Infectious Diseases 2001 ; 33 : 527–532.
[13] Jensen AG, et al. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. Journal of Infection 1997 ; 34 : 113–118.