Discitis and Back Pain

Discitis is relatively uncommon but it usually affects children under the age of ten. It is a low grade infection, usually caused by staphylococcus or a virus. It affects the disc space between two vertebrae and develops very slowly. Medical experts say this should be viewed in the same category as vertebral oseomyelitis (infection within the vertebrae). It can lead to severe, debilitating, neurological damage.

Disease Process
The infection does not start primarily in the in disc space but migrates there from other sources in the body. Urinary tract infections, pneumonia, and soft tissue infections are believed to be the most common sources. Often, no site of infection is discovered. The lumbar(lower) back is affected most often, followed by the cervical spine(neck) and last is the thoracic spine (upper back). Some post-surgical patients have developed the disease weeks after their operation, and, in their case disease diagnosis is not delayed. They rarely develop neurological deficits.

The edges of the disc erode and the degree depends upon the amount of infection and destruction within the disc. These areas become calcified, once healing begins, and, eventually, there is an interbody fusion, when healing is completed

Disease in Adults
This infection has a slow, insidious onset which can result in diagnosis being delayed for months. Pain in the back and neck are the most common complaints and movement makes it worse. Because the symptoms are similar to those of back strain, there is usually a delay in seeking medical attention. A doctor is often not seen until the sufferer develops an elevated temperature and chills, with weight loss. This delay can lead to a severe condition and the mortality rate (death rate) ranges between 2% to 12%. It more commonly affects males, with a ratio of 2:1 that has gone as high as 5:1.

Disease in Children
The onset is often more sudden, acute, and the back pain is accompanied by a refusal to walk, sit up, and there is extreme irritability. There may be localized tenderness over the spine and decreased range of motion.

Common Symptoms in Adults And Children
• Elevated temperature
• Chills
• Sweating
• Feeling of fatigue
• Loss of appetite
• Localized tenderness of spine
• Pain may travel to other parts of the body, including abdomen, hip, leg, groin.
• Movement aggravates pain.

Diagnosis
• Laboratory studies
• Sputum cultures may be done to isolate bacteria for diagnosis.
• Blood Culture
• X-rays of spine may show narrowing of disc space.
• Nuclear scan of spine
• CT Scan (Computerized Tomography)
• MRI (Magnetic Resonance Imaging)
• Echocardiogram can identify bacterial endocarditis which is responsible for some cases of discitis.
• Needle Biopsy of painful area to obtain tissue for culture

Treatment
• Antibiotics specific to kill organism once it’s identified
• IVs for hydration and supportive care
• Immobilization is necessary.
• Usually 2 weeks of bedrest
• Back brace when patient is able to ambulate
o This allows vertebrae to fuse in an aligned position.
• Bracing may be necessary for 3 to 6 months following treatment to avoid collapse of vertebrae and development of kyphosis ( curvature of spine – ‘round back’)

Discitis occurrence in the US ranges from 1 in 100,000 to 1 in 250,000 but in less developed countries, it is more common. In some parts of Africa, 11% of all patients seen for back pain were diagnosed with discitis.