Spondylodiscitis

A Spondylodiscitis With an incidence of 1: 250,000, is a rare inflammatory infection of the intervertebral disc with involvement of the adjacent vertebral bodies. With an average ratio of 3: 1, men are more likely to suffer from spondylodiscitis than women, with the age peak usually between the ages of 50 and 70.

What is spondylodiscitis?

As Spondylodiscitis is a rare inflammation of the intervertebral disc space and the adjacent vertebral bodies, which is usually due to a bacterial infection.

The disease is assigned to the spectrum of osteomyelitis (bone or bone marrow inflammation). Spondylodiscitis is often characterized by initially unspecific symptoms, which is why the disease is only diagnosed after two to six months in many cases. In general, depending on the underlying cause, a distinction is made between endogenous and exogenous spondylodiscitis.

In the case of endogenous spondylodiscitis, the triggering focus of infection is located in structures remote from the vertebral body, from which the pathogens colonize one or more vertebral bodies via hematogenous spread (via the bloodstream), often affecting the ventral segments of the vertebral column. In contrast, exogenous spondylodiscitis is caused, among other things, by injections close to the vertebral body or surgical interventions.

causes

A Spondylodiscitis In most cases this can be traced back to a primary infection of the intervertebral disc by bacteria, fungi or, in rare cases, parasites, with bacterial colonization in most cases.

The most common bacterial pathogens here are Staphylococcus aureus and Escherichia coli with 30 to 80 percent. In addition, spondylodiscitis with inflammatory rheumatic diseases such as rheumatoid arthritis or ankylosing spondylitis, exposure to chemical noxae, for example in the context of enzymatic chemonucleolysis, as well as in rarely associated with lumbar disc surgery (between 0.1% and 3%).

The pathogens affect the intervertebral disc endogenously or exogenously and spread to the adjacent vertebral bodies, where they cause destructive processes in the bone tissue. Endogenous spondylodiscitis is caused in many cases by tuberculosis, which later also manifests itself in the skeleton or the spine (tuberculous spondylodiscitis).

Symptoms, ailments & signs

Spondylodiscitis or inflammation of the intervertebral disc manifests itself through very different symptoms and forms. The location and cause of the inflammation are decisive for the symptoms. In addition to completely inconspicuous courses, there are also life-threatening septic disease courses. At the beginning there are generally hardly any symptoms, so that the spondylodiscitis usually remains undetected at first.

Then a phase can follow in which the pain quickly worsens. The pain usually occurs locally on the affected area. These are pressure or knocking pains that increase with stress. Pain in the cervical spine often radiates to the neck and arms. If there is inflammation in the lumbar spine, the pain often radiates to the legs.

The mobility of the spine is severely restricted. If the inflammation spreads, the pain is no longer localized but affects the entire back. The most common form of spondylodiscitis is caused by a bacterial infection. In the context of bacterial spondylodiscitis, in addition to the typical pain, there is also fever, fatigue and aching limbs, i.e. signs of a general infection.

In rare cases, neurological deficits, symptoms of paralysis and severe irritation of the nerve roots are also possible with spondylodiscitis. The nerve root irritation exacerbates the entire pain situation in the body. They cause the pain outside the actual source of pain to be felt even more strongly in other areas of the body.

Diagnosis & course

A suspicion of the presence of one Spondylodiscitis results from characteristic clinical symptoms such as knocking, heel drop and compression pain with little or no pressure pain, relieving posture and pain when standing up and during inclination (bending forward).

The diagnosis is confirmed by imaging procedures (X-ray, CT, MRT), which also allow an assessment of the changes in the spine and the inflammatory processes. In addition, especially in acute cases, the inflammation markers in the serum (including CRP, leukocytes) and the erythrocyte sedimentation rate (ESR) are increased. In the differential diagnosis, spondylodiscitis should be differentiated from erosive osteochondrosis, tumor-related destruction, ankylosing spondylarthritis and Scheuermann's disease.

If untreated, spondylodiscitis can have severe symptoms with a life-threatening course (around 70 percent). If left untreated, spondylodiscitis can also lead to immobility, pseudarthroses, malpositions and a chronic pain syndrome. The prognosis for spondylodiscitis depends on the severity of the disease. In many cases, especially with progressive destruction of the vertebral bodies, post-therapeutic complaints (including motor deficits, hypoesthesia) can be observed.

Complications

Spondylodiscitis primarily leads to severe pain in the affected person. In most cases, this occurs in the form of tenderness. However, they can also occur in the form of resting pain and have a negative effect on the sleep of the person concerned. The patients suffer from sleep problems and thus possibly from depression or other mental disorders.

Spondylodiscitis can also lead to fever and general tiredness and fatigue in the patient. Some people also lose weight and have night sweats. The quality of life of the patient is honestly limited and reduced by the spondylodiscitis. Treatment for this disease is usually done without complications. With the help of medication, the symptoms can be limited and the infection alleviated.

However, painkillers should not be taken over a long period of time as they can damage the stomach. In severe cases, spondylodiscitis can also lead to blood poisoning, which can lead to death. However, if treatment is successful, the patient's life expectancy will not be negatively restricted or reduced.

When should you go to the doctor?

A doctor is required in the event of restricted mobility, pain in the limbs or symptoms of paralysis. Pain, sensitivity disorders, fever and fatigue are other complaints that need to be investigated and treated. A general malaise, a decrease in physical and mental performance and irritability are indications of spondylodiscitis. A doctor must be consulted for diagnosis. An individual treatment plan is then drawn up based on the existing complaints.

If pain is present, pain reliever medication should never be taken on your own responsibility. Consultation with a doctor should be sought beforehand to avoid risks and side effects. If a light tap or pressure on the affected area leads to a significant increase in the symptoms, further examinations are necessary to clarify the cause. Unsteady gait, an increased risk of accidents and the avoidance of movements indicate illness.

If there are also behavioral problems or emotional irregularities, the observations should be discussed with a doctor. Since spondylodiscitis can lead to blood poisoning in severe cases, there is a potential danger to life. An internal sensation of heat or a spread of existing abnormalities should be presented to a doctor as soon as possible. Sweating or sleep disorders are also common symptoms of the disease, such as mood swings or fatigue. It is advisable to consult a doctor immediately.

Treatment & Therapy

The therapeutic measures include in one Spondylodiscitis First and foremost, adequate immobilization (including orthotics and / or bed rest) and protection of the specifically affected section of the spine as well as antibiotic, antifungal or antiparasitic therapy.

The basis of the treatment of bacterial spondylodiscitis is the detection of the specifically present pathogen, which can be done using a blood culture or (intraoperative) biopsy, as well as the resistogram or antibiogram. In the case of pronounced acute spondylodiscitis, antibiotic broad-spectrum therapy can be started before the resistogram is available, although this should take into account the most likely pathogens (Staphylococcus aureus, Escherichia coli).

The antibiotics are administered intravenously or parenterally (past the intestine) for the first two to four weeks. If the inflammation parameters are normalized and the general condition of the person affected is improved, it can usually be switched to oral intake. An extension of the antibiotic therapy is recommended for risk groups.

If the spondylodiscitis is caused by a mycotic or parasitic infection, an antifungal or antiparasitic therapy is used analogously. At the same time, existing pain symptoms should be treated accordingly with analgesics (painkillers).

If sepsis, neurological deficits, instabilities and / or potential deformities can be found in the affected spinal column segments or if the conservative measures are unsuccessful, surgical intervention can be carried out to remove the focus of infection causing the spondylodiscitis (debridement) and to stabilize the affected spinal column segment (chip interposition ) must be displayed.

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prevention

One Spondylodiscitis can be prevented through adequate therapy of infectious diseases. Diabetes mellitus, renal insufficiency, obesity, tumors, tuberculosis, systemic diseases, drug abuse, heart and circulatory diseases as well as HIV are predisposing factors and should be treated promptly and consistently in order to prevent spondylodiscitis.

Aftercare

Since spondylodiscitis cannot heal on its own, the person affected should first and foremost consult a doctor at an early stage to prevent other complaints and complications from occurring. In many cases, the follow-up measures are significantly limited or are not even available to those affected.

In most cases of spondylodiscitis it is necessary to take various medications in order to limit the symptoms and relieve them completely. The person affected should always pay attention to the correct dosage and regular intake in order to counteract the symptoms properly. If anything is unclear or if you have any questions, you should always consult a doctor first.

The doctor should also be consulted if there are severe side effects. When taking antibiotics, it should be noted that they should not be taken together with alcohol in order not to impair the effect. Furthermore, regular checks by a doctor are very important even after successful treatment. Spondylodiscitis usually does not reduce the life expectancy of those affected.

You can do that yourself

The acute phase often exceeds a period of 8 weeks, regardless of whether conservative or surgical treatment is sought. During this time, absolute bed rest must be observed. The patient should therefore deal with a stabilizing trunk orthosis as soon as possible so that they can change their position in bed autonomously. Furthermore, you have to learn how to use a bedpan and how to eat on your side, because sitting for long periods and hunched over are absolutely contraindicated. The positioning cushions for spinal column relief must be placed under the legs at regular intervals in the supine position. In addition, the patient or the carer must check the skin for pressure points and decubitus ulcers on a daily basis.

After the acute phase, most of them begin to adapt permanently to the changed physiological movement sequences and restrictions. For this, it is necessary to strive for optimal pain treatment with medication, physiotherapy and physical measures. It may be necessary to adapt the workplace, for example by converting the desk into a stand-sit desk.

In addition to weight adjustment, a pain- and phase-adapted movement should be focused to build muscle in the back and stomach.A back-friendly redesign of everyday life means, for example, that no loads over 5 kg should be lifted, no shoes with heels should be worn and no mattress with a raised headboard should be chosen.