Spondylodiscitis - a silent infection with loud consequences

The aim of this study is to present a case of a patient with spondylodiscitis. Spondylodiscitis is a infection of the spine involving the vertebral body and/or intervertebral disc, often caused by Staphylococcus aureus and Enterobacteriaceae. It most commonly affects the lumbar spine, begins in the vertebral body endplates and can lead to destruction of bone structures and involvement of the intervertebral disc and surrounding tissues. A 53-year-old man developed lumbar spine pain after an infection of unknown origin accompanied by fever and weakness. After two weeks, when the pain worsened and radiated to the left buttock, an MR examination showed features of L3/L4 spondylodiscitis. During hospitalization, a follow-up MR examination revealed destruction of the L3 and L4 vertebral bodies, inflammatory changes within the L3/L4 intervertebral disc, and widening of the intervertebral space. Inflammatory granules in the anterior part of the spinal canal with slight pressure on the meningeal sac were identified. A CT scan confirmed vertebral destruction. Empirical antibiotic therapy (clindamycin, ceftriaxone, vancomycin, rifampicin) was followed by spinal stabilization. After a year, CT scan showed improvement - reduced destruction of the L3/L4 vertebral bodies and no palpable infiltrative lesions. The stabilizing material was removed. Spondylodiscitis is a infection of the spine, often diagnosed late because of nonspecific symptoms such as back pain and fever. The MRI is the gold standard for diagnosis. Diagnosis is based on clinical, laboratory and imaging findings. It requires the cooperation of surgeons, radiologists and microbiologists. Early detection improves prognosis and quality of life.