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. 2008 Mar;105(10):181-7.
doi: 10.3238/arztebl.2008.0181. Epub 2008 Mar 7.

Current diagnosis and treatment of spondylodiscitis

Rolf Sobottke  1 , Harald Seifert, Gerd Fätkenheuer, Matthias Schmidt, Axel Gossmann, Peer Eysel
Affiliations

Current diagnosis and treatment of spondylodiscitis

Rolf Sobottke et al. Dtsch Arztebl Int. 2008 Mar.

Abstract

Introduction: Infection of the spinal column is rare, and often recognized and treated too late. Spondylodiscitis is osteomyelitis of the spine and can cause severe symptoms. Hospital mortality is in the region of 2% to 17%.

Methods: Selective literature review and results of the authors' own research.

Results: The incidence of pyogenic spondylodiscitis is around 1 : 250 000, which represents around 3% to 5% of osteomyelitis as a whole. 10% to 15% of all vertebral infections can be ascribed to exogenous spondylodiscitis, with Staphylococcus aureus as the commonest pathogen, 2% to 16% of which are reported to be MRSA (methicillin-resistant S. aureus). Catheter-related, nosocomial infection with MRSA is a key cause for spondylodiscitis. 50% of all skeletal tuberculoses are found in the spine.

Discussion: Spondylodiscitis should be borne in mind in cases of diffuse back pain and non-specific symptoms. MRI is the diagnostic modality of choice for detecting spondylodiscitis. Thanks to precise monitoring of conservative treatments and primarily stable surgical techniques, prolonged immobilization of the patient is no longer necessary nowadays.

Keywords: spinal infection; spine; spondylitis; spondylodiscitis; vertebral osteomyelitis.

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Figures

Figure 1
Figure 1
MRI: sagittal and axial cross-sections: T1 and contrast medium in a patient with specific spondylitis (atypical mycobacteria: Mycobacterium xenopi) at the level of thoracic vertebral body 10
Figure 2
Figure 2
Fluorine-18 fluorodeoxyglucose PET (FDG PET) shows marked excess enrichment over several segments (circa thoracic vertebral bodies 9 to 12), with a standard uptake value (SUV max) of 9.1.
Figure 3
Figure 3
Algorithm for the intraoperative removal of tissue samples
Figure 4
Figure 4
Cervical non-specific spondylodiscitis in cervical vertebral bodies 3/4 and postoperative native radiological follow-up with properly positioned bone span and plate
Figure 5
Figure 5
Three month postoperative native radiological follow-up after bilateral dorsoventral spondylodesis of thoracic vertebral bodies 2 and 3
Figure 6
Figure 6
CT in recurrent spondylodiscitis one year after dorsoventral fusion
See this image and copyright information in PMC

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