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Disc space infection




Iatrogenic: following surgery or disc cannulation

Can be primary in childhood

Spontaneously occuring spinal infections in adults involving the discs are due to osteomyelitis of the vertebral body - probably beginning in the end plate, not discitis


Childhood Discitis       

Menelaus M.B. Discitis JBJS 46B: 16-23, 1964

Wenger etal The spectrum of intervertebral disc space infection in children JBJS 60A:100-108, 1978





Back pain

Difficulty walking or sitting
May be assoc with fever, malaise
May be preceded by URTI etc
Reduced motion, muscle spasm, abnormal posture





ESR up

WCC usually normal
Blood cultures - +ve in 50%

> 6 wks post onset of symptoms organisms do not appear to isolated from blood cultures



early normal
later - disc narrowing

progressive end plate lesions

erosion into the vertebral body
latest - fusion rare,  very little residual disc narrowing




Rest - until no pain or limitation of motion, and until ESR normal

Antibiotics- indicated if febrile, +ve blood cultures, +ve biopsy, IV until pt comfortable, then oral for 3 more wks



Good- spontaneous recovery is almost the rule


Adult Discitis



Discectomy, after open discectomy: 0-2.8%

Discography, 2 % without and 0.7 % with stilleted needles (0 % if Ab’s mixed in)

Chemonucleolysis,  up to 2 %

Percutaneous nucleotomy

Lumbar puncture



Bacterial contamination



Bacteria introduced into disc

Progressive thinning of end plate with immature granulation tissue forming on the vertebral side of the end plate at 1 wk

By 3 wks the end plates are breached and nuclear material herniates into the vertebral body  - bacteria are destroyed in a florid vascular response

By 6 wks new bone is forming , disc material is replaced by granulation tissue




Pain - severe, disabling, present at rest
Muscle spasm

Posture abnormal


Investigation -    


ESR up

WCC usually normal
Cultures usually negative



Plain films initially normal

Disc narrowing at  2-3 wks

End plate erosions at 6 wks

Bone scan



Prophylaxis - sterile technique

Antibiotics are unable to arrest the progression of discitis once the

condition is established

Once the end plate is penetrated, antibiotics may have a role in prevention of vertebral osteomyelitis

Rest - support- may need to be for 6-8 mths

Anterior clearance and fusion if symptoms demand




IV or intradiscal antibiotics during discography have not been conclusively shown to decrease the rate of discitis over sterile technique alone.


Both single- and double-needle techniques when used with stylettes are superior to nonstyletted techniques.


Is a slowly resolving process in the majority discitis following open discectomy follows a more refractory course with most pts having disabling symptoms after 5 yrs

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