Discitis
The spondylodiscitis is an inflammation of the intervertebral disc and the two adjacent vertebral bodies, mostly due to bacterial infections, inflammatory rheumatic diseases, however caused.
Symptoms
Symptoms are initially nonspecific, the pain correspond in strength and spread those that can be caused by degenerative changes in the spine as well. Pain occurs especially at night or during exercise and are sometimes accompanied by night sweats, fever or weight loss. Very characteristic is a strong knock and tenderness of the affected vertebrae.
Pathogen
By far the most common pathogen is Staphylococcus aureus, Staphylococcus epidermidis are rare, Streptococcus viridans, Escherichia coli, Pseudomonas aeruginosa, Pneumococcus, Clostridium perfringens, Proteus mirabilis, Haemophilus aphrophilus, Mycobacterium tuberculosis or Veillonella parvula.
Diagnosis
The laboratory data can provide an indication of an inflammatory process, but can also remain inconspicuous. Radiographically, the disc tissue in the later stage appears compressed, initially is often not a pathological findings to be seen. Information often brings the MRI scan, a CT scan can also provide clues. A pathogen is possible under certain circumstances by blood cultures.
Therapy
Depending on the severity of the clinical picture of the inevitable, intensive antibiotic treatment may need to be supplemented by operational measures. An operation is especially necessary when a calculated antibiotic does not lead to improvement or resolution of neurological deficits occur. The disc tissue is surgically removed, the adjacent vertebral bodies locked together to prevent any movement in the affected segment. To secure the pathogen and resistance determination, a CT-guided biopsy can sometimes be applied.
The parties concerned must always, even with conservative treatment, follow a strict bed rest for 6-8 weeks. In addition, a stabilizing trunk orthosis is given. The necessary treatment and monitoring of the course usually last long, usually well over one year.