Discospondylitis

Question 1

What is discospondylitis?

Answer 1

• infectious inflammation within the nucleus pulposus of the disc
• i.e. effectively a walled off abscess

Question 2

Presentation

Answer 2

• chronic pain
• usually chronic progressive spinal pain without neurological deficits that may be focal on palpation or difficult to localise
• can occasionally progress to ataxia or some paresis

Question 3

Diagnosis

Answer 3

• radiography in chronic cases by demonstrating destruction of the vertebral body endplates, this is usually accompanied by secondary spondylosis
  – it can occur at multiple sites along the spine or in a single disc
  – it is commonly seen at the LS junction
• radiography may be normal in early cases and diagnosis may require advanced imaging such as CT to make a diagnosis
• some authors recommend blood and urine culture to try identify the bacteria and allow C&ST
• some sites, esp the LS junction, may be amenable to FNA to attempt bacteriology to guide AB choice

Question 4

Tx

Answer 4

• in the UK most cases are bacterial and tx can be started with broad spectrum antibiotics
  – usually a 6w course of antibiotics is required
• in other countries fungal discospondylitis may occur more frequently

Question 5

In more recent years what has there been an increase in? Why?

Answer 5

• increasing frequency of Brucella discospondylitis in Romanian imported dogs