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Intervertebral disc space infection: another low back syndrome of the young
Abstract:
Pyogenic disc space infection is a rare and unappreciated cause of low back pain. Reported herein is a young man with chronic low back pain and the HLA-B27 antigen which initially led to the diagnosis of ankylosing spondylitis. However, serial lumbar radiographs and bone scan established an inflammatory lesion involving the L2-L3 intervertebral disc space, and persistently normal sacroiliac joints. A needle biopsy and culture of the disc space yielded Staphylococuss aureus. Treatment with antibiotics, bed rest and back bracing resulted in a complete resolution of symptoms and healing of the vertebral lesion. It is the purpose of this report to review the clinical, laboratory and radiographic features of intervertebral disc space infection as well as pitfalls in its diagnosis.
Insights
Pyogenic disc space infection, a rare cause of low back pain, was diagnosed in a young man. Prompt antibiotic treatment and supportive care led to complete symptom resolution and healing.
Area of Science:
- Orthopedics
- Infectious Diseases
- Radiology
Background:
- Pyogenic disc space infection is an uncommon cause of low back pain.
- The HLA-B27 antigen can complicate diagnosis, initially suggesting ankylosing spondylitis.
- Differentiating infection from other inflammatory conditions is crucial.
Observation:
- A young male patient presented with chronic low back pain and a positive HLA-B27 antigen.
- Serial lumbar radiographs and bone scan revealed an inflammatory lesion at the L2-L3 intervertebral disc space.
- Sacroiliac joints remained normal, atypical for ankylosing spondylitis.
Findings:
- Needle biopsy and culture of the disc space identified Staphylococcuss aureus.
- Treatment involved antibiotics, bed rest, and back bracing.
- Complete resolution of symptoms and healing of the vertebral lesion were achieved.
Implications:
- Highlights the importance of considering pyogenic disc space infection in low back pain cases, especially with atypical presentations.
- Emphasizes the diagnostic challenges and the role of imaging and biopsy in accurate diagnosis.
- Demonstrates the effectiveness of conservative management for intervertebral disc space infections.