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
    • May have radicular symptoms
  • Fever (60-70%)
  • Neuro deficits (10-50%)
  • ESR elevation (>90%)
  • Leukocytosis (<50%)

Differential Diagnosis

Spinal infection

Lower Back Pain

Evaluation

  • Labs
    • ESR elevated
  • Imaging
    • Plain films are rarely positive
    • MRI is gold standard

Management

IV Antibiotics

  • Treatment targets S. aureus, Streptococcus, Pseudomonas, E. coli

Inpatient Therapy

Use cefepime or ciprofloxacin if targeting Pseudomonas spp

Disposition

  • Admit

References

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