[Spondylitis--spondylodiscitis. Pathologico-anatomical morphology and diagnostic problems]

Inflammatory disorders of the spine usually develop in the medullary space of the vertebral bodies, and this clinical picture is identified as spondylitis. If the inflammation involves the intervertebral disk as well as adjacent vertebrae, this lesion is defined as spondylodiscitis. Spondylitis may be brought about by several causes which should be diagnostically clearly defined in order to introduce a suitable therapy. In many cases, no conclusions can be drawn from the radiological structures alone with respect to the underlying disease, an additional biopsy investigation (e.g., by a needle puncture) is therefore required. Most infections conditions of spondylitis represent histologically either an acute, purulent or a chronic, unspecific osteomyelitis. The causative germs are determined by simultaneous bacteriological investigation. The biopsy material of specific spondylitis shows typical histological granulomas which, together with the bacteriological findings, will allow a precise diagnosis to be established. Both spondylitis and spondylodiscitis may also be produced by fungi that can be histologically identified. Parasites (e.g., Echinococci) may also be recognized histologically. In spondylitis of unknown etiology the histological structures do not have a pathognomonic appearance, and therefore clinical and radiological findings should be included in the diagnosis. Diagnostic problems will only be solved by considering a synthesis of all findings.