Spondylodiscitis is a combination of discitis ( inflammation of one or more intervertebral disc spaces) and spondylitis (inflammation of one or more vertebrae), the latter generally involving the areas adjacent to the intervertebral disc space. ^[1]

Causes

Spondylodiscitis is the most common complication of sepsis or local infection, usually in the form of an abscess. ^[2] The main causative organisms are staphylococci, but potential organisms include a large number of bacteria, fungi, zoonoses. ^[2] Spondylodiscitis frequently develops in immunocompromised individuals, such as by a cancer, infection, or by immunosuppressive drugs used for organ transplantations. ^[2]

Diagnosis

The main methods to diagnose a spondylodiscitis are magnetic resonance imaging (MRI), biopsy and microbiological tests such as PCR to determine an infectious cause. ^[2]

Treatment

Approximately 90% of cases can be treated conservatively. ^[3] In the absence of spinal cord/nerve root compression and lack of data on instability of the inflamed segment, conservative treatment with:

• Antibiotics - empirical treatment should start AFTER biopsy material for microbiological testing is obtained (PMID 27082590). The following empirical treatment may be administered for a total of 6 weeks (PMID 26872859): - Ceftriaxone 2x2g and Clindamycin 3x600mg i.v. for 2 weeks - Ciprofloxacin 2x500mg and Clindamycin 4x300mg p.o. for 4 more weeks If the pathogen can be identified - antibiotic treatment should be adapted to the susceptibilities of the microorganism.
• Bed rest

References

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