26. Diskospondylitis

Question 1

What vasculature supplies each vertebra?

Answer 1

vertebral, intercostal, lumbar artery ending in capillary bed in the vertebral endplate.
The IVD is avascular.

Question 2

What is the most common route of spinal infection? What are the most common sources?

Answer 2

Arterial spread.
Urogenital, oral cavity, heart valves and skin.

Question 3

What vertebrae are most commonly affected by migrating FB (like plant awns) and why?

Answer 3

L2 and L4. Because when inhaled, it migrates through the lungs, or mediastinum to the origin of the diaphragm at the ventral margin of these vertebrae.

Question 4

What are the most common agents of Diskospondylitis?

Answer 4

Staphylococcus spp, Brucella spp, Streptococcus spp, Escherichia coli

Question 5

Which breed appears predisposed to systemic aspergillosis?

Answer 5

German shepherd, 67% of cases, hereditary immune defect suspected.

Question 6

Which agent causing diskospondylitis do we have to be careful with and why?

Answer 6

Brucella canis, zoonotic, zone south-eastern of USA at higher risk (10% of diskospondylitis)

Question 7

What are the predisposing factors?

Answer 7

Male > female, 6-9 yo, large breed dogs (great dane, labradors), chondrodystrophic dogs are uncommonly affected.

Question 8

T or F:
Fever and weight loss are common findings on physical exam.

Answer 8

F - only in 1/3 of animals presenting diskospondylitis.

Question 9

What are the classic radiographic findings?

Answer 9

• collapse of the IVD space
• bone lysis centered at the vertebral endplate
• sclerosis
• spondylosis

Question 10

T or F:
CSF analysis is often normal.

Answer 10

True.
The disease is extradural. Some mild, non-specific changes can be present.

Question 11

What test should you do in case of suspicion of diskospondylitis to rule out Brucella spp?

Answer 11

• Start with serology: slide agglutination test.
• If positive: tube agglutination test (TAT) or agar gel immunodiffusion (AGID) test.
• Bacterial culture –> advise laboratory as infection can occur through aerosolization from culture growth.

Question 12

In case of suspicion of systemic aspergillosis, which sample is more specific for fungal culture?

Answer 12

Urine.
Culture of blood, and aspirates of any abnormal-appearing organs is also recommended.

Question 13

Treatment: what would you use for pain control?

Answer 13

Tramadol, gabapentin and NSAIDs. Corticosteroids are contraindicated.

Question 14

What initial empiric antibiotic is used? And when should we expect to see improvement?

Answer 14

cephalexin, first 5 days

Question 15

In case, Brucella is confirmed to be the causative agent, what drug protocol have been used (antibiotic)?

Answer 15

tetracyclines + ahminoglycosides + fluoroquinolones. Dogs should be castrated or spayed.