Spondylodiszitis

Spondylodiszitis

With an incidence of 1:250,000, spondylodiscitis is a rare inflammatory infection of the intervertebral disc involving the adjacent vertebral bodies. With an average ratio of 3:1, men are more frequently affected by spondylodiscitis than women, with the peak age usually being between the ages of 50 and 70.

What is spondylodiscitis?

Spondylodiscitis is a rare inflammation of the intervertebral disc space and the adjacent vertebral bodies, which is usually due to a bacterial infection. For lethargy overview, please visit homethodology.com.

The disease is assigned to the spectrum of osteomyelitis (bone or bone marrow inflammation ). Spondylodiscitis is often characterized by initially non-specific symptoms, which is why the disease is often only diagnosed after two to six months. In general, depending on the underlying cause, a distinction is made between endogenous and exogenous spondylodiscitis.

In the case of endogenous spondylodiscitis, the triggering focus of infection is in structures distant from the vertebral body, from which the pathogens colonize one or more vertebral bodies via hematogenous spread (via the bloodstream), whereby the ventral spinal column segments are often affected. In contrast, exogenous spondylodiscitis is caused, among other things, by injections close to the vertebral body or surgical interventions.

Causes

In most cases, spondylodiscitis can be traced back to a primary infection of the intervertebral disc by bacteria, fungi or, in rare cases, parasites, with bacterial colonization usually being present.

The most common bacterial pathogens are Staphylococcus aureus and Escherichia coli, with 30 to 80 percent rarely associated with lumbar disc surgery (between 0.1 to 3%).

The pathogens attack the intervertebral disc endogenously or exogenously and spread to the adjacent vertebral bodies, where they cause destructive processes in the bone tissue. In many cases, endogenous spondylodiscitis is caused by tuberculosis, which later also manifests itself in the skeleton or spine (tuberculous spondylodiscitis).

Symptoms, Ailments & Signs

Spondylodiscitis or disc inflammation manifests itself through very different symptoms and forms. The location and cause of the inflammation are decisive for the symptoms. In addition to completely inconspicuous courses, there are also life-threatening septic courses of the disease. At the beginning there are generally hardly any symptoms, so that the spondylodiscitis usually remains undetected at first.

This can be followed by a phase in which the pain quickly worsens. The pain is usually local to the affected area. This is pressure or percussion pain that worsens with exertion. Pain in the cervical spine often radiates to the neck and arms. In the case of inflammation in the area of ​​the lumbar spine, the pain often radiates into the legs.

The mobility of the spine is severely restricted. If the inflammation spreads, the pain is no longer localized, but affects the entire back. The most common form of spondylodiscitis is caused by a bacterial infection. In the context of bacterial spondylodiscitis, in addition to the typical pain, there is also fever, exhaustion and body aches, i.e. signs of a general infection.

In rare cases, spondylodiscitis can also cause neurological deficits, signs of paralysis and severe irritation of the nerve roots. The nerve root irritation exacerbates the entire pain situation in the body. They cause the pain to be felt even more intensely in other parts of the body outside of the actual source of pain.

Diagnosis & History

A suspicion of the presence of spondylodiscitis results from characteristic clinical symptoms such as pain from percussion, heel drop and sprain pain with little to no pressure pain, relieving posture and pain when standing up and during inclination (bending forward).

The diagnosis is backed up by imaging procedures ( X- ray, CT, MRI ), which also allow an assessment of the changes in the spine and the inflammatory processes. In addition, the inflammatory markers in the serum (including CRP, leukocytes ) and the blood sedimentation rate (ESR) are increased, especially in acute cases. In terms of differential diagnosis, spondylodiscitis should be distinguished from erosive osteochondrosis, tumor-related destruction, ankylosing spondylarthritis and Scheuermann’s disease, among other things.

Spondylodiscitis, especially if left untreated, can have severe symptoms with a life-threatening course (about 70 percent). If left untreated, spondylodiscitis can also lead to immobility, non-unions, malpositions and chronic pain syndrome. The prognosis for spondylodiscitis depends on the severity of the disease. In many cases, especially in the case of progressive destruction of the vertebral bodies, post-therapeutic symptoms (including motor deficits, hypaesthesia) can be observed.

Complications

Spondylodiscitis primarily causes severe pain in those affected. In most cases, this occurs in the form of pressure pain. However, they can also occur in the form of rest pain and have a negative effect on the sleep of the person concerned. The patients suffer from insomnia and thus possibly from depression or other mental disorders.

Spondylodiscitis can also lead to fever and general tiredness and exhaustion in the patient. Some sufferers also lose weight and may suffer from night sweats. The quality of life of the patient is honestly restricted and reduced by the spondylodiscitis. Treatment of this disease is usually without complications. With the help of medication, the symptoms can be very well limited and the infection alleviated.

However, painkillers should not be taken over a longer period of time, as they can damage the stomach. In severe cases, spondylodiscitis can also lead to blood poisoning, which can lead to the death of the person affected. If the treatment is successful, however, the life expectancy of the patient is not negatively restricted or reduced.

When should you go to the doctor?

A doctor is required in the event of restricted mobility, joint pain or signs of paralysis. Pain, sensory disturbances, fever and exhaustion are other complaints that need to be examined and treated. A general malaise, a decrease in physical and mental performance, and irritability are indications of spondylodiscitis. A doctor must be consulted for diagnosis. An individual treatment plan is then drawn up based on the existing symptoms.

If pain is present, you should never take painkilling medication on your own responsibility. To avoid risks and side effects, consultation with a doctor should be sought beforehand. If a slight tapping or pressing on the affected area leads to a significant increase in symptoms, further investigations are necessary to clarify the cause. Unsteady gait, an increased risk of accidents and the avoidance of movements indicate a disease.

If there are also behavioral problems or emotional irregularities, the observations should be discussed with a doctor. Since spondylodiscitis can lead to blood poisoning in severe cases, there is a potential danger to life. An inner sensation of heat or the spread of existing abnormalities should be presented to a doctor as soon as possible. Sweating or sleep disturbances are also among the usual symptoms of the disease, as are mood swings and fatigue. It is advisable to consult a doctor immediately.

Treatment & Therapy

In the case of spondylodiscitis, the therapeutic measures primarily include adequate immobilisation (including orthoses and/or bed rest ) and protection of the specifically affected section of the spine, as well as antibiotic, antimycotic or antiparasitic therapy.

The basis for the treatment of bacterial spondylodiscitis is the detection of the specific pathogen present, which can be done using a blood culture or (intraoperative) biopsy, as well as the resistogram or antibiogram. In the case of pronounced acute spondylodiscitis, broad-spectrum antibiotic therapy can be started even before the resistogram is available, although this should take into account the most likely pathogens (Staphylococcus aureus, Escherichia coli).

The antibiotics are administered intravenously or parenterally (past the intestines) for the first two to four weeks. If the inflammation parameters are normal and the general condition of the person affected is improved, it is usually possible to switch to oral administration. In risk groups, an extension of antibiotic therapy is recommended.

If the spondylodiscitis is caused by a mycotic or parasitic infection, an antimycotic or antiparasitic therapy is used analogously. At the same time, existing pain symptoms should be treated accordingly with analgesics ( painkillers ).

If sepsis, neurological deficits, instability and/or potential deformities are found in the affected spinal column sections, or if conservative measures are not successful, surgical intervention to remove the focus of infection causing the spondylodiscitis (debridement) and stabilize the affected spinal column segment (span interposition ) to be displayed.

Prevention

Spondylodiscitis can be prevented by adequate treatment of infectious diseases. Diabetes mellitus, renal insufficiency, obesity, tumors, tuberculosis, systemic diseases, drug abuse, heart and circulatory diseases as well as HIV are considered predisposition factors and should be treated early and consistently to prevent spondylodiscitis.

Aftercare

Since spondylodiscitis cannot heal on its own, the person affected should primarily consult a doctor at an early stage in order to prevent the occurrence of other symptoms and complications. In many cases, the aftercare measures are significantly limited or are not even available to those affected.

In most cases, spondylodiscitis requires the use of various medications to limit and completely relieve the symptoms. The person concerned should always ensure that the dosage is correct and that it is taken regularly in order to counteract the symptoms properly. If anything is unclear or you have any questions, you should always consult a doctor first.

The doctor should also be consulted in the event of severe side effects. When taking antibiotics, it should be noted that they should not be taken together with alcohol, so as not to impair the effect. Regular check-ups by a doctor are also very important after successful treatment. Spondylodiscitis does not usually reduce the life expectancy of the person affected.

You can do that yourself

The acute phase often exceeds a period of 8 weeks, regardless of whether conservative or surgical treatment is sought. Absolute bed rest must be observed during this time. The handling of a stabilizing trunk orthosis should therefore be taken over by the patient themselves as soon as possible in order to be able to change their position in bed autonomously. You should also learn how to use a bedpan and eat while lying on your side, as prolonged sitting and a hunched posture are absolutely contraindicated. The positioning cushions to relieve the spine must be placed under the legs at regular intervals in the supine position. In addition, the daily check of the skin for pressure points and developing decubitus ulcers on the part of the patient or the caregiver is obligatory.

After the acute phase, a permanent adjustment to the changed physiological movement sequences and limitations begins for most of them. For this it is necessary to strive for optimal pain treatment with medication, physiotherapy and physical measures. It may be necessary to adapt the workplace, for example by converting the desk into a sit-stand desk.

In addition to weight adjustment, a pain- and phase-adapted movement to build muscle in the back and abdomen should also be focused on. A back-friendly reorganization of everyday life means, for example, that no loads over 5 kg should be lifted, no shoes with heels should be worn and no mattresses with a raised headboard should be chosen.

Spondylodiszitis