Discitis
Background
- Infection in the intervertebral disc space
- occurs post surgically in approximately 1-2% of patients after spinal surgery.
- Infection of nucleus pulposus due to infection of vertebral body end-plate cartilage
- Risk Factors: pediatric patients (age < 8yo), post-op, immunocompromised
Clinical Features
- >90% present with unremitting neck or back pain which awakens them at night
- Fever (60-70%)
- Neuro deficits (10-50%)
- ESR elevation (>90%)
- Leukocytosis (<50%)
Differential Diagnosis
CT of an infected disc at the level of C5-C6 causing neurological symptoms
MRI of discitis in a 2 year old child.
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Spinal fracture
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Renal disease
- Kidney stone
- Pyelonephritis
- Nephrolithiasis
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- PID
- Other
Evaluation
- Labs
- ESR elevated
- Imaging
- Plain films are rarely positive
- MRI is gold standard
Management
Inpatient Therapy
- Vancomycin 15-20 mg/kg IV BID PLUS any of the following:
- Ceftriaxone 2g IV daily
- Cefepime 2g IV IV three times daily
- Ceftazidime 2g IV three times daily
- Ciprofloxacin 400mg IV three times daily
Use cefepime or ciprofloxacin if targeting Pseudomonas spp
Disposition
- Admit
References
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