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Spontaneous infectious discitis in adults

M Honan1, G W White, G M Eisenberg

  • 1Division of Rheumatology, Lutheran General Hospital, Park Ridge, Illinois, USA.

The American Journal of Medicine
|January 1, 1996
PubMed
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Spontaneous infectious discitis is an uncommon cause of adult low back pain. Early diagnosis with imaging and blood/disc cultures is critical for effective antibiotic treatment, even with diverse causative organisms.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Radiology

Background:

  • Discitis, an infection of the intervertebral disc space, most commonly occurs post-operatively in adults.
  • Spontaneous infectious discitis is a rare condition that requires careful consideration in the differential diagnosis of low back pain.

Observation:

  • This study reviewed 16 adult patients with spontaneous infectious discitis and compared them with 52 cases from the literature.
  • A wide array of microorganisms were identified as causative agents, differing from previous reports.
  • Blood cultures were negative in 90% of patients with positive disc cultures.

Findings:

  • Magnetic resonance imaging (MRI) demonstrated the highest sensitivity and specificity for diagnosing discitis compared to nuclear imaging and computed tomography (CT).

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  • Antibiotic therapy was curative in all but one patient, irrespective of symptom duration.
  • Culture of blood and/or disc is crucial for identifying the specific pathogen.

    • Implications:

    • Spontaneous infectious discitis should be considered in adults presenting with acute or subacute low back pain.
    • Elevated acute-phase reactants combined with appropriate imaging can suggest the diagnosis.
    • Prompt identification of the causative organism through cultures is essential for successful treatment outcomes.