From the Guidelines
Discitis typically presents with back pain that is often severe, persistent, and worsens with movement, and the most recent and highest quality study 1 suggests that MRI is the gold standard for diagnosis, showing decreased disc height, endplate erosions, and enhancement of the disc and adjacent vertebrae.
Key Features of Discitis
- Back pain that is severe, persistent, and worsens with movement
- Fever
- Limited spinal mobility
- Neurological symptoms such as weakness, numbness, or tingling in the extremities
- Elevated inflammatory markers (ESR, CRP) and sometimes leukocytosis
- Blood cultures may be positive in 50-70% of cases
Diagnosis
- MRI is the gold standard for diagnosis, showing decreased disc height, endplate erosions, and enhancement of the disc and adjacent vertebrae 1
- CT scans can demonstrate bony destruction
- Plain radiographs may initially be normal but later show disc space narrowing
- Biopsy may be necessary to identify the causative organism, commonly Staphylococcus aureus
Treatment
- Treatment typically involves 6-12 weeks of antibiotics, initially intravenous then oral, based on culture results 1
- Empiric therapy often includes vancomycin plus a third-generation cephalosporin until culture results guide targeted therapy
- Pain management, spinal immobilization, and occasionally surgical debridement for abscesses or severe neurological compromise are important components of management
- Early diagnosis is essential to prevent complications such as spinal deformity, chronic pain, or neurological deficits 1
From the Research
Discitis Presentation
- Discitis is a serious condition that can present with severe back pain and restriction of spinal movements, as seen in two elderly patients (aged 70 and 80 years) in a study published in 2000 2.
- The characteristic feature of discitis is the development of increasingly severe back pain, which is not relieved by rest or narcotic analgesics, as described in a study published in 2006 3.
- Discitis can be caused by pyogenic organisms and can lead to serious complications, such as vertebral osteomyelitis or the formation of an epidural abscess, if left untreated or not properly managed 3, 4.
- The majority of cases of discitis are caused by Staphylococcus spp (40.3%) and involve the lumbosacral region (52.3%), as reported in a systematic review published in 2019 4.
- Discitis can also be associated with neurological compromise, abscess development, and segmental instability, which can lead to spinal cord compression and neurological deficits 4.
Clinical Features
- Severe back pain and restriction of spinal movements are common presenting features of discitis 2, 3.
- Inflammatory markers are often raised in patients with discitis, which can help in diagnosis 2.
- Computed tomography (CT) findings can confirm the diagnosis of discitis, as seen in the study published in 2000 2.
- Abscesses can develop in patients with discitis, which can be treated percutaneously or with open surgery, depending on the location and severity of the abscess 4.
Treatment
- Antibiotic therapy is often used to treat discitis, with ceftriaxone being a widely favored choice of antibiotic 3, 5.
- The timing of antibiotic administration is crucial in preventing or treating discitis, and high-performance liquid chromatography can be used to detect the concentration of cephazolin in the plasma and disc 3.
- A once-daily dose of ceftriaxone 2g can be considered for systemic infections, including spondylodiscitis, with Cutibacterium acnes, using a clinical breakpoint of ≤0.5mg/L 5.