What is spondylodiscitis (inflammation of the intervertebral disc and adjacent vertebrae)?

From the Guidelines

Spondylodiscitis is an infection that affects both the vertebral body and the adjacent intervertebral disc in the spine, typically developing through bloodstream infection, direct inoculation, or spread from adjacent infected tissues, and is characterized by inflammation, pain, and potential structural damage. This condition can be caused by various pathogens, including bacteria, fungi, or other microorganisms, and often presents with symptoms such as persistent back pain, fever, limited mobility, and neurological symptoms if the infection compresses the spinal cord or nerve roots.

Key Characteristics of Spondylodiscitis

• Involves the vertebral body (spondylo) and the adjacent intervertebral disc (discitis)
• Typically develops through hematogenous spread, direct inoculation during surgery or procedures, or spread from adjacent infected tissues
• Common causative organisms include Staphylococcus aureus, Escherichia coli, and Mycobacterium tuberculosis
• Patients usually present with persistent back pain, fever, limited mobility, and neurological symptoms

Diagnosis and Treatment

• Diagnosis requires blood cultures, imaging (MRI is most sensitive), and sometimes biopsy, as noted in 1
• Treatment involves a prolonged course of antibiotics (typically 6-12 weeks) targeted to the specific pathogen, often starting with intravenous therapy followed by oral medication, with common regimens including vancomycin, ceftriaxone, or ciprofloxacin, depending on the causative organism, as discussed in 1
• Severe cases may require surgical intervention to drain abscesses, remove infected tissue, or stabilize the spine, highlighting the importance of early diagnosis and appropriate treatment to prevent complications like spinal deformity, neurological deficits, or sepsis, as emphasized in 1

Imaging and Diagnostic Criteria

• MRI is the most sensitive imaging modality for diagnosing spondylodiscitis, with a sensitivity of 97%, specificity of 93%, and an accuracy of 94%, as reported in 1
• The inability to distinguish the margins between the disc space and adjacent vertebral marrow on T1-weighted images, associated with increased signal intensity from the disc and the adjacent involved marrow on T2-weighted images, is a hallmark of bacterial spondylodiscitis, as described in 1
• Extension of the infectious process to the paravertebral space, causing an epidural abscess or a paravertebral abscess, is best seen on gadolinium-enhanced MRI, as noted in 1

From the Research

Definition of Spondylodiscitis

• Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies 2.
• It is a severe infectious disease of the intervertebral discs and of the adjacent parts of the vertebral bodies, culminating in destruction of the mobile segment 3.
• The term spondylodiscitis describes the infection of both the intervertebral disc space and the adjacent vertebrae 4.

Causes and Symptoms

• The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites 2.
• In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80% 2.
• The main symptom is massive back pain, combined with a moderate CRP elevation, and occasionally fever 5.
• Neurological deficits are registered in up to 50% of patients 2.

Diagnosis and Treatment

• CT-guided aspiration - in addition to blood cultures - improved the detection rate for the causative pathogen from 49 to 82% 5.
• MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods 2.
• Pathogen detection and establishment of an optimal antibiotic regimen are cornerstones of successful conservative therapy for spondylodiscitis 5.
• A standardised antibiotic therapy for spondylodiscitis has not been clearly defined, but pathogen detection is important, with focused antibiotic therapy 2.
• Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification 2.