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PubMedDate not supplied

Pyogenic infectious spondylitis in children: the convergence of discitis and vertebral osteomyelitis.

The outcomes of 47 patients, ranging in age from 7 months to 15 years, 8 months (average, 4 years, 8 months) with presumed pyogenic infectious spondylitis (so-called discitis) were evaluated retrospectively with regard to duration and recurrence of symptoms, and the need for readmission, retreatment, or surgical intervention. Among nonimmobilized patients, 18% (four of 22) receiving intravenous antibiotics, 50% (five of 10) receiving oral antibiotics, and 67% (four of six) receiving no antibiotics (analgesics and bed rest only) had either prolonged or recurrent symptoms or both. Among patients treated with spinal immobilization, one of five receiving concomitant intravenous antibiotics and two of two receiving no antibiotics had a recurrence of symptoms following discontinuation of immobilization. Two patients required surgical drainage of paraspinal abscesses (one cervical and one lumbar). These findings support the contention that so-called discitis is simply pyogenic infectious spondylitis in children and suggest that specific treatment with intravenous antibiotics is more likely to lead to rapid relief of symptoms and signs without recurrence.

Administration, Oral↗
PubMed1990

Role of bone scintigraphy in the early diagnosis of discitis.

Nine cases of recorded discitis are presented, in which scintigraphy played an important part in the diagnosis. The patients (five men (aged 21-75 years) and four women (aged 40-73 years)) had a history of back pain varying in duration from two days to three months. Final diagnosis was confirmed microbiologically (seven patients) or radiographically (two patients). Bone scintigraphy was a valuable diagnostic procedure for discitis with earlier detection than plain radiography in three patients and similar initial detection to that of third generation computed tomography. Single photon emission computed tomographic imaging increased diagnostic confidence by indicating the involvement of the adjacent vertebral bodies rather than of the pedicles or spinous processes.

Adult↗
PubMed1998

Unusual aetiology of persistent back pain in a patient with multiple myeloma: infectious discitis.

A 47 year old man with multiple myeloma presented with persistent back pain caused by infectious discitis. Aspiration of the affected vertebral disc space was carried out, guided by computed tomography, and microbiological examination of the aspirate revealed Staphylococcus aureus and Mycobacterium tuberculosis. Antituberculous and antistaphylococcal antibiotic treatment resulted in a dramatic clinical response with complete resolution of the vertebral abscess. Detailed radiological and microbiological investigations are necessary to diagnose unusual causes of chronic bone pain such as discitis or infectious bone disease in patients with multiple myeloma.

Discitis↗
PubMed1994

Post lumbar puncture discitis and vertebral collapse.

Discitis and vertebral collapse are rare but serious complications of lumbar puncture. Clinical profile, management and course of post lumbar puncture discitis in five patients is presented. Such a complication should be kept in mind whenever any invasive procedure is carried out on the spine.

Adult↗
PubMed1994

Acute purulent discitis with epidural abscess of the cervical spine in an adult--case report.

A 52-year-old male presented with acute purulent discitis and epidural abscess of the cervical spine manifesting as neck pain and slight fever, followed by sudden onset of quadriparesis. Magnetic resonance (MR) imaging showed a low-signal-intensity area in the C6/7 disc space and epidural space ventral to the spinal cord with peripheral enhancement. Surgical exploration using an anterior approach revealed local discitis and epidural abscess, but no osteomyelitis of the neighboring vertebral bodies. Six months after the decompressive procedure to treat the purulent disc and epidural abscess, he had achieved almost full recovery. Such lesions are rare in adults, but should be considered especially when painful spinal symptoms are associated with fever. Early and definitive diagnosis can be achieved by MR imaging with enhancement.

Brain Abscess↗
PubMed1992

Prognosis in postoperative discitis. A retrospective study of 111 cases.

111 cases of postoperative discitis during 1968-1986 were analyzed retrospectively. The diagnosis was confirmed by lumbar tomography. Low back pain appeared at an average of 16 days postoperatively. Laboratory findings were of minor value in the diagnosis since elevated ESR, white blood cell count, and body temperature were inconstant findings. Compared with a matched control group, there was a higher incidence of chronic low back pain and vocational handicap in the discitis patients. There was no difference in the consumption of analgetics, the subjective evaluation of the final outcome, spinal mobility or neurologic findings.

Adult↗
PubMed2000

Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia.

We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. Magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin B administration with a total dose of 2.0 g. Discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.

Aspergillosis↗
PubMed1992

[Postoperative lumbar discitis].

The authors report our experience on 19 cases of discitis developed after operations for herniated lumbar disc. Because of the negativity of the neuroradiological studies in the acute stage, the recognition of the typical syndrome (severe back pain, spasm of the paravertebral lumbar muscles, limited spinal motility, fever) beginning 3-30 days post-operatively and the study of some laboratory tests (elevated Erythrocyte sedimentation rate (ESR) and midly to moderately elevated white blood cells (WBC) are very important for diagnosis. The first radiographic findings (disc space narrowing, ecc.) are detectable only 4 to 6 weeks after the first symptoms; other X-ray findings are not seen post-operatively before 6 months-2 years. The CT-scan is diagnostic of discitis only when the following three specific signs are present: a) anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes; b) fragmentation or erosion of vertebral end plates; c) paravertebral fluid collection (abscess). In our experience a period of immobilization of the spine with a plaster body jackets and the use of adequate antibiotic therapy are the more effective treatment. Undoubtedly the discits are the results of an infection that must be prevented adhering to the aseptic principles not only during surgery but also during the procedures performed in the radiology suite.

Adult↗
PubMed1989

Lumbar discitis in a patient with quadriplegia: case report.

The diagnosis of septic discitis, or vertebral osteomyelitis, in able-bodied adults is difficult to make and often delayed. Here, the clinical findings and events leading to diagnosis and complications of septic discitis occurring in a patient with quadriplegia after urinary tract manipulation are presented. The diagnosis was delayed nine weeks from onset of fever (11 weeks after urologic manipulation), despite a variety of radiologic procedures and repeated blood and urine cultures. The patient's symptoms recurred five weeks after IV antibiotics were discontinued and while he was still taking oral cephalexin. He underwent open debridement and further IV and IM tobramycin, recovering without complication. The patient died five months later, reportedly of bowel obstruction and pneumonia. A review of the literature revealed only one other case report, of a patient with paraplegia, who also presented a diagnostic problem and died one year after diagnosis.

Aged↗
PubMed1993

[2 children with discitis].

The childhood form of discitis was diagnosed in a 2-year-old girl and a 5-year-old boy. They presented with an antalgic posture, muscular defense and a positive Gowers sign. Characteristic symptoms of this childhood discitis form the triad: unexplained fever, increased erythrocyte sedimentation rate and symptomatic narrowing of an intervertebral space.

Braces↗
PubMed1997

[Discitis in childhood: integrated neuroradiological imaging in diagnosis and follow-up study of one case].

Discitis is an inflammatory disease of the intervertebral disc which has usually a benign evolution in childhood. It often recognizes an infectious etiology. Still discussed however is the possibility of a primitive discal involvement (not secondary to a vertebral inflammation) or of a non infectious etiology and the subsequent more correct diagnostic-therapeutic procedures. We report a case of a girl with discitis diagnosed early and treated with antibiotics and orthopedic corset, whose follow-up shows a benign evolution. We underline the importance of modern neuroradiological imaging: in particular, MR plays a major role in the inflammatory diseases of the column, both in diagnosis and in follow-up. MR scans of the involved disc allow frequent controls without radiogenic risks and with a good resolution because of the multiplanarity typical of the method.

Anti-Infective Agents↗
PubMed1998

Two cases of discitis due to Propionibacterium acnes.

We report two cases of discitis due to Propionibacterium acnes and review previously published cases of bone and joint infections in which this organism was recovered as a pure culture. P. acnes is an anaerobic organism usually considered a normal inhabitant of the skin but capable of producing a variety of infections including discitis, osteitis, arthritis, and chest wall osteitis. Most patients were immunocompetent. A few infections occurred spontaneously, whereas others were secondary to a break in the skin or to implantation of foreign material into the body for instance during internal fixation of a fracture or arthroplasty. Cases of P. acnes chest wall infection have been reported in patients with palmoplantar pustulosis or chronic or multifocal osteitis, supporting a role for P. acnes in SAPHO syndrome.

Adult↗
PubMed1981

Discitis--a rare early symptom of ankylosing spondylitis.

This case report describes a patient who suffered from backache at the age of 12 years. The initial diagnosis was Scheuermann's disease but repeated examinations showed a progressive discitis, without signs of arthritis of the sacro-iliac joints. There was also a recurring effusion of the left knee. Three years later the clinical and radiological evaluation showed irreversible immobilisation of the dorsolumbar spine, whereas the sacro-iliac joints were mildly affected. Discitis seems to be a rare early symptom of ankylosing spondylitis.

Adolescent↗
PubMed1987

Diagnosis of discitis by SPECT technetium-99m MDP scintigram. A case report.

A 29-year-old male presented with a two month history of intermittent low back pain following a febrile illness. Two planar bone scans performed with Tc-99m MDP were normal despite roentgenographic and SPECT scintigraphic evidence of discitis. This case demonstrates the increased sensitivity of SPECT in the diagnosis of discitis.

Adult↗
PubMed1978

Bone scintigraphy in discitis and related disorders in children.

Thirty-nine children with suspected pathology involving the vertebral column were investigated haematologically, radiographically, and by bone scintigraphy using technetium 99M pyrophosphate. Fifteen children were shown to have inflammatory disease of the vertebrae. A further six suffered from Scheuermann's disease, two from benign tumours, and the remainder from miscellaneous diseases not specifically involving bony pathology. The nuclide scan was abnormal in all cases of discitis and osteomyelitis, and in the two tumours. All of the other conditions were associated with a normal bone scan. This finding is of considerable diagnostic importance, and leads support to the theory that discitis is due to bacterial infection.

Adolescent↗
PubMed1983

Juvenile discitis.

Over a period of three years four girls and two boys presented with discitis. All were less than 5 years old at presentation, and each had a short history of symptoms. Three were initially thought to have pathological defects of the abdomen. All children showed abnormal posturing with exaggerated lumbar lordosis. Diagnosis was essentially clinical. All cultures were sterile. The erythrocyte sedimentation rate was increased in all the children and all had mild pyrexia. Symptoms lasted from two to 8 weeks. Discitis should be considered in any child with fever, abnormal posturing, and refusal to walk. Early recognition may avoid unnecessary diagnostic and treatment procedures.

Anti-Bacterial Agents↗
PubMed1986

Gowers' sign in discitis in childhood.

Three cases of discitis in early childhood presented with acute refusal to walk or change in gait pattern without neurologic deficits. In all three, a Gowers' sign was observed, although none had muscular weakness. The diagnosis of discitis was confirmed by the characteristic radiographic findings on survey lumbosacral films and/or by a hot spot at the L3 level on technetium bone scan.

Child, Preschool↗
PubMedDate not supplied

Septic Discitis.

The clinical and laboratory findings in 15 patients with septic discitis are reported. The clinical picture was that of a sub-acute illness characterized by back pain, spinous process tenderness, and sciatic nerve root irritation. There was a considerable delay from clinical presentation to diagnosis (average 14 wk). The erythrocyte sedimentation rate was the most useful diagnostic laboratory blood test and the best indicator of disease activity. The relative value of plain radiographs, tomography, and radionuclide bone scans is discussed. Needle aspiration of the disc space was found to be a useful diagnostic test. We found that a diagnosis of septic discitis could be made even in the absence of positive bacterial cultures from various biologic fluids or from the disc space. Long-term oral and intravenous antibiotic therapy with controlled rest resulted in a favourable outcome.

Adolescent↗