Discitis

Discitis is an infection in the intervertebral disc space. It can lead to serious complications such as sepsis or an epidural abscess.

Features

• Back pain
• General features
  • pyrexia,
  • rigors
  • sepsis
• Neurological features
  • e.g. changing lower limb neurology
  • if an epidural abscess develops

Causes

• Bacterial
  • Staphylococcus aureus is the most common cause of discitis
• Viral
• TB
• Aseptic

Diagnosis

• Imaging: MRI has the highest sensitivity
• CT-guided biopsy may be required to guide antimicrobial treatment

MRI (T2) showing discitis in a middle-aged man. High signal intensity mass anterior to vertebral bodies and in T10-T11 disc space with surrounding inflammation - e Image used on license from Radiopaedia

MRI images show enhancement of the C4 and C5 vertebral bodies, along with narrowing of the disc space and irregular end plates. A rim-enhancing fluid collection extends upwards, causing slight compression and flattening of the spinal cord

Treatment

• The standard therapy requires six to eight weeks of intravenous antibiotic therapy