discitis

What is Discitis?

Discitis, also known as diskitis, is an infection in the intervertebral disc space that affects different age groups [3]. It is a serious but uncommon medical diagnosis [10].

Causes and Symptoms

The most telling symptom of discitis osteomyelitis is persistent back pain in a specific area that gets worse with movement or pressure [4]. You may also notice inflammation of an INTERVERTEBRAL DISC or disk space which may lead to disk erosion [6][8]. In children, symptoms include irritability, refusal to walk, and difficulty sitting or standing [13].

Demographics

Discitis is usually seen in children younger than 10 years and in adults around 50 years of age [15]. Men are more affected than women.

Diagnosis

Discitis is usually diagnosed through a combination of medical history, physical examination, labs, and imaging tests [9]. The healthcare provider will ask about the symptoms and the location and severity of the pain. They will also ask about your medical history and any risk factors for infection.

Note: Discitis often accompanies another condition called osteomyelitis, which is an infection that can affect your bones and bone marrow [1].

Common Signs and Symptoms of Discitis

Discitis, an inflammation between the intervertebral discs of your spine, can manifest in various ways depending on its severity and location. Here are some common signs and symptoms to look out for:

• Persistent back pain: This is often the primary symptom of discitis, typically located in the lower or upper back.
• Pain that worsens with movement or activity: As the condition progresses, pain may intensify when moving or engaging in physical activities.
• Tenderness and swelling in the affected area: The spine's affected region may become tender to touch and swollen due to inflammation.
• Stiffness and limited range of motion: Discitis can cause stiffness and reduced mobility in the spine, making it difficult to move or perform daily activities.

Additional Symptoms

In some cases, discitis may present with additional symptoms, including:

• Fever: A fever can be a sign of infection, which is often associated with discitis.
• Weakness: As the condition progresses, weakness in the affected area may develop.
• Numbness or tingling: Nerve compression or damage due to discitis can cause numbness or tingling sensations.
• Difficulty walking or standing: In severe cases, discitis can lead to difficulty walking or standing due to pain and stiffness.

Age-Related Symptoms

It's essential to note that symptoms may vary depending on the age of the patient. Children with discitis may experience back pain, refusal to walk, or even abdominal pain, whereas adults may exhibit more severe symptoms like sepsis or epidural abscess.

These symptoms can help identify discitis and prompt medical attention. Early diagnosis is crucial in preventing complications and ensuring effective treatment.

References:

• [2] - Symptoms of discitis include gradual onset of severe back pain, fever, chills sweating, and stiffness.
• [4] - Symptoms of discitis can vary depending on its severity, although common signs and symptoms include: Persistent, localized back pain, usually in the lower back or neck Pain that worsens with movement or activity Tenderness and swelling in the affected area of the spine Stiffness and limited range of motion in the spine
• [5] - Signs and symptoms of discitis osteomyelitis · Fever · Back pain that doesn't get better by taking pain relievers, applying heat or resting · Weakness · Numbness ...
• [10] - Symptoms of Discitis. The symptoms of discitis can vary depending on the severity of the infection and the location of the infected disc. Common symptoms may include: Back pain; Fever; Weakness; Weight loss; Numbness or tingling; Difficulty walking or standing;
• [13] - Symptoms include severe back pain, leading to lack of mobility.

Discitis, also known as diskitis, is an inflammation that develops between the intervertebral discs of your spine. To diagnose this condition, several diagnostic tests can be used.

Imaging Tests: These tests are usually MRIs or X-rays, used to take pictures of the spine and its surrounding tissues. An MRI scan is considered the best and most sure diagnosis for discitis, as it can show the infection in the intervertebral discs [3]. Blood tests are not sufficient on their own to make a definitive diagnosis.

Blood Tests: These tests reveal indicators of an infection, such as an elevated white blood cell count. However, they are not specific enough to confirm the diagnosis of discitis [7][11].

Bone Scans: To examine the vertebrae and the spaces around them to assess the vitality of the bone tissue.

Tissue Analysis: This test includes a biopsy, which is usually performed percutaneously or open, to make the definitive diagnosis of discitis or osteomyelitis [2].

Physical Exam and Review of Symptoms: Your doctor will do a physical exam and review your symptoms and medical history. Blood tests play a crucial role in diagnosing discitis osteomyelitis [8].

It's worth noting that accurate diagnosis of discitis is essential for effective treatment, and the diagnostic process typically involves a combination of clinical evaluation, laboratory tests, and imaging studies [15].

Treatment Options for Discitis

Discitis, an infection of the intervertebral disc space, requires prompt and effective treatment to prevent further complications. The primary goal of drug treatment is to eliminate the infection and alleviate symptoms.

• Antibiotics: Antibiotic therapy plays a crucial role in treating discitis. The choice of antibiotics depends on the isolated organism and any other sites of infection. Broad-spectrum antibiotics are used if no organism is isolated, but this is rare (1). Commonly used antibiotics include vancomycin, quinolones, rifampicin, linezolid, and gentamycin (6).
• Duration of Treatment: The standard therapy requires six to eight weeks of intravenous antibiotic therapy (3, 7). This prolonged treatment duration is necessary to ensure that the infection is fully cleared.
• Pain Management: Pain is treated with analgesics, and patients

Discitis Differential Diagnosis

Discitis, an inflammation of the vertebral disk space often related to infection, can be challenging to diagnose due to its similarity with other medical conditions. A differential diagnosis is a process of ruling out other possible causes of symptoms before arriving at a final diagnosis.

Possible Conditions to Consider:

• Spinal epidural abscess: A rare but serious condition where an abscess forms in the space between the spinal cord and the vertebrae.
• Pyelonephritis: A type of kidney infection that can cause back pain and other symptoms similar to discitis.
• Rheumatoid arthritis: An autoimmune disorder that can cause inflammation and pain in various joints, including those in the spine.
• Osteomyelitis: An infection of the bone and bone marrow that can be accompanied by discitis.
• Charcot joint: A condition where there is a loss of sensation and movement in a joint, leading to degeneration and deformity.
• Modic type I endplate change: A condition characterized by changes in the vertebral endplates, which can mimic the appearance of discitis on imaging studies.

Key Points:

• Early diagnosis and treatment of discitis are crucial for a better prognosis [1].
• Delayed diagnosis can lead to poorer outcomes [2].
• Imaging modalities such as MRI scans can help confirm the diagnosis of discitis [4].

References:

[1] Early diagnosis and treatment of discitis are correlated with a better prognosis. [2] A delay in diagnosis leads to poorer outcomes. [3] Spinal epidural abscess, pyelonephritis, rheumatoid arthritis, osteomyelitis, Charcot joint, and Modic type I endplate change are possible differential diagnoses for discitis. [4] MRI scans can help confirm the diagnosis of discitis.