Spine discitis

Question 1

Degenerative disc disease RF and aetiology

Answer 1

Degenerative disc disease is often related to aging; the factors which precipitate damage to the intervertebral discs include:

Progressive dehydration of the nucleus pulposus
Daily activities causing tears in the annulus fibrosis
Injuries or pathology resulting in instability
Including mechanical insults (such as spinal fractures), iatrogenic injuries (such as spinal surgery), or systemic metabolic processes (such as osteoporosis)

Question 2

Clinical signs of Degenerative disc disease

Answer 2

Early stage disease symptoms are often localised and the clinical examination may be unremarkable
Potential signs:
local spinal tenderness, hypomobility, or painful extension of the back or neck

When the disc degeneration progresses to cause instability, the pain may become more severe and include RADICULOPATHY- LMN, leg pain or paraesthesia.
Pain may be reproduced by passively raising the extended leg

care with- cauda equina, spinal compression

Further disease progression may demonstrate signs of worsening muscle tenderness, stiffness, reduced movement (particularly lumbar region), and scoliosis.

Question 3

Degenerative cervical myelopathy CLinical

Answer 3

disc degeneration leading to compression of the C-spine- very dangerous and to consider in anyone over 50 with progressive arm neuro

affects all nerve under the area of compressions- its a type of spinal compression
Patients report neurological symptoms such as pain and numbness in limbs, poor coordination, imbalance, and bladder problems

o Hoffman’s sign (thumb adduction/flexion +/− finger flexion after forced flexion and sudden release of a finger, distally)
Segmental weakness (corresponding to the level of compression)
Upper Motor Neuron signs in arms and legs
PROGRESSIVE
MSK pain in neck
Bladder/ANS sx

Lhermitte’s sign (electric shock sensation down the spine, or into the limbs, on neck flexion or extension, present in severe cases)

Need urgent MRI and decompressive surgery

Question 4

Degenerative disc disease Ix and mx

Answer 4

MRI Spine is GS

if
Red flags present (faecal incontinence or urinary, saddle anaesthesia, immunosuppression or chronic steroid use, intravenous drug abuse, unexplained fever, significant trauma, osteoporosis or metabolic bone disease, new onset after 50 years old, or a history of malignancy)

Radiculopathy with pain for more than 6 weeks

Evidence of a spinal cord compression

Imaging would significantly alter management

mx-if no red flag- anesthesia and after acute stage- physio

Question 5

Discitis

Answer 5

Infection of spinal disc—Back pain (think back pain with sepsis+neuro)
Staphylococcus aureus_ofc

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

ix and mx
MRI is GS, CT can be used for biopsy

mx- The standard therapy requires six to eight weeks of intravenous antibiotic therapy