Diskitis or Discitis
Infection affecting the intervertebral disc spaces, May affect one or several levels. Two percentage of the spinal infection are iatrogenic after spinal surgical interventions. The causative organisms are variable but it could be pyogenic bacteria or it could mycobacterium which is the causative agent of tuberculosis. The infection may cause infection in the blood stream, or locally with destruction of the adjacent vertebral bodies and lead to spondylidiscitits which is serious condition may cause spinal mechanical instability, or may cause compression of the neural tissue. It also may cause pus collection inside the spinal canal, epidural abscess which may lead to compression of the spinal cord and the nerve roots.
Clinical features are variable, depending on the site, extent and the rapidity of progression of the infection. Most common feature is the back or neck pain, restriction of movement, constitutional symptoms like fever, rigor, and fatigue. In advance cases, it may cause neurological deterioration like weakness or paralysis of the limbs, sphincters and even death if it’s not treated appropriately.
Diagnosis of discitis/discospondylitis is usually achieved by clinical evaluation of the patient, general blood tests to check the inflammatory markers, radiology investigation in form different types of imaging like X-rays, CT scan, MRI scan etc . Definite diagnosis of the bacteria is usually by isolation of the bugs from blood or from direct aspiration of infection site.
Management is complex and need inpatient admission. Antibiotics are the keystone of management, usually implemented under supervision of microbiology team. However, emergency neurosurgical intervention may be necessary in certain situation. The management is variable and should be case based assessment. The main indications for neurosurgical interventions are as follow:
-For tissue sampling to identify the causative organism which lead to use an appropriate antibiotic to eradicate the infection. Fine needle aspiration or laminectomy is usual procedure.
-For spinal cord and /or nerves decompression, when there is pressure at the neural tissues by the collecting pus or granulation tissues. Laminectomies, anterior cervical Discectomy (ACDF), Corpectomy with or without spinal fusion are the procedures may need for this condition.
-For spinal column stabilization, when there is significant destruction of the vertebra, joints and ligaments by infection, it would cause spinal instability. Spinal stabilization would include insertion of metal implants to stabilize the spinal column.