What is Discitis?
Discitis is also called as diskitis is an inflammation of vertebral disc space at the spine. These are uncommon problems that affect the different age groups but, most of the time it affects children 8 years old and below. Other times, this also happens as a complication of post spinal surgeries, but it only happens about 1-2% of the time.
The spine is made up of vertebra and it serves as the building blocks of the spinal area. The vertebra have bony prominences that act as a support for mobilization and at the same time protection of the spinal cord. The spinal cord is an essential organ since it is responsible for movements and even sensation.
Although the vertebra are bony, there are discs that and fibrous tissues above it to act as cushion when the person moves around. Sometimes, due to aging and other factors, it breaks or herniates causing infection, and other life threatening diseases.
Discitis Symptoms and Signs
There are noticeable symptoms related to discitis. This includes very severe back pain that leads to lack in mobility like walking. This is usually felt a week after a spinal surgery wherein the patient will feel lower back pain or even neck pain. In children however, the severity of the back pain makes them refuse to move around and even bend their back.
Discitis Causes and Risk Factors
For post-operative discitis, physicians linked it with an aseptic technique either in preparation of the surgery or invasion of the skin flora into the vertebral area. Usually, before surgeries, the health care team should follow strict aseptic technique in order to avoid infection of the exposed area. For instance, if staph aureus is able to penetrate into the spinal area, it can cause infection like discitis.
Other linked causes of Discitis also involve hematologic infection from the urinary or respiratory area. This means that the bacteria is able to go through the blood stream and travel into the vertebral area which leads to discitis.
1. Septic discitis
This type of discitis is referred as the direct seeding of bacteria into the vertebral disk space. This is a rare type of discitis and it may be classified depending on its source if it is hematogenous, post-operative and contagious. Most of the time, the bacteria responsible for Discitis is the S. aureus, but it can also be due to other microorganisms like S. epidermidis, E. coli and others.
2. Infectious discitis
When the problem is associated with other signs and symptoms like fever, sweats, chills, loss of appetite and others. This is due to the invading microorganism on the vertebral space of the spinal column.
3. Lumbar discitis
This presents when the problem is at the lumbar area of the spinal column. Thus the discitis is self-limiting or does not infect other disc
4. Osteomyelitis discitis
Osteomyelitis is a common condition wherein it affects the bones through inflammatory process. Osteomyelitis may be chronic or acute. However, the bones that are affected is found in the vertebral area or in the spinal column, this is associated with osteomyelitis discitis and the causative agent are mostly microorganisms.
Diagnostic tools for direct imaging of the spinal column or the vertebra are requested by the doctors. This includes MRI, plain or contrast x-rays and even CT scans.
Initially, the physician would suggest plan x-rays and they will see swelling of the vertebral area. To make sure about the correct diagnosis, physicians will request for MRI. The MRI shows some changes in the structure of the vertebral disc and even point out further involvement of other organs and surrounding tissues.
Blood samples will also be taken to measure the white blood count of the patient.
The immediate care for Discitis is to give patients antibiotics and to immobilize or rest the patient. Rest is very well needed to promote recovery from the inflammation. Immobilization also gives the vertebrae the time to fuse in with the anatomical structure of the body. A 2-week complete bed rest is suggested by the doctors and when the patient moves out of bed, they need to wear back brace to assist them when moving around.
Bracing the back is suggested to be worn for 3-6 months and if the patient feels back pain, he or she needs to rest as soon as possible.
On the other hand, antibiotic treatment is needed to kill the microorganism responsible for Discitis. Usually, physicians would suggest broad spectrum antibiotics if the blood samples for culture is not yet found out. Sometimes, IV antibiotics will be given for 6 to 8 weeks to effectively kill the microorganism but the health care team should also monitor the neurologic functions and the ESR rate of the patient.
There are only few and not life threatening complications of Discitis. This includes
- chronic back pain and
- neck pain. These are usually due to the side effects of the medications taken.
Discitis when treated properly have good prognosis to patients. The patients are cured with the combination of medications, rest and sometimes surgery of necessary. Only about 15% of the patients showed permanent neurological damage but it is not fatal.
Observe the redness in between the 2 vertebral disc space