What Is Spondylodiscitis?
Spondylodiscitis is a medical condition in which there is infection of the intervertebral disc along with infection of the vertebrae.1 This infection leads to a medical condition called as osteomyelitis in the spinal column. Spondylodiscitis is basically of two types which are endogenous and exogenous. In Endogenous Spondylodiscitis, the primary infection begins quite far away from the vertebral system and then the infection reaches the vertebral bodies through the blood. The inflammation then spreads to the ventral sections of spinal column; whereas in Exogenous Spondylodiscitis the root cause may be some sort of surgical procedure or any injection to the vertebral column. Bacteria that tend to cause this condition can be staphylococci or mycobacterium tuberculosis.
What Causes Spondylodiscitis?
To understand the cause of Spondylodiscitis, it is important to understand the anatomy of the spinal column. The spinal column consists of the intervertebral discs, which is situated between the superior and the inferior vertebral bodies. It also consists of nucleus pulposus which acts as shock absorber during axial loading of the vertebral bodies. A vertebral body consists of the following parts:
- Body of the discs which facilitates weight bearing
- The vertebral arch whose function is to protect the spinal cord
- The articular processes which help in restriction of motion.
Any type of infection which begins in these parts or spreads to these parts from other parts of the body causes Spondylodiscitis.
Studies state that Spondylodiscitis affects males more than females and the incidence of Spondylodiscitis increases with age.2 Some of the risk factors which predispose an individual to Spondylodiscitis are medical conditions like diabetes mellitus or cardiac conditions. The main bacteria which cause Spondylodiscitis are staphylococci and mycobacterium tuberculosis.
What Are The Symptoms Of Spondylodiscitis?
An individual affected with Spondylodiscitis will complain of pain and discomfort when walking, especially on heel strike. The affected individual will try and avoid stressing the spinal column. There is also pain experienced with inclination or bending forward and then straightening up. Some of the other symptoms of Spondylodiscitis are:
- Severe back pain with also neck pain 3
- Neck pain radiating to the chest or abdomen
- There will also be neurological symptoms like weakness of the legs, paralysis of the extremities, altered sensation
- Fever in rare cases is also seen with Spondylodiscitis
- The most common symptom will be visible spine deformities like kyphosis
- Another symptom for Spondylodiscitis is that of unintentional weight loss.
How Is Spondylodiscitis Diagnosed?
Since Spondylodiscitis is quite a rare medical condition hence diagnosing it is quite difficult and the condition is often at times misdiagnosed as back pain can be caused due to numerous medical conditions. Some of the tests which the primary physician may conduct in order to diagnose Spondylodiscitis are:
MRI and CT scan to rule out other conditions causing the patient symptoms. When other conditions are ruled out then the physician may conduct a tissue biopsy along with a microbiological test to find out the cause of the infection causing the symptoms and thus confirming the diagnosis of Spondylodiscitis.
How Is Spondylodiscitis Treated?
Spondylodiscitis when confirmed requires conservative treatment to get rid of the problem. In order to treat Spondylodiscitis, the mode of treatment is an extensive course of antibiotics to get rid of the infection causing the disease and then a course of the immobilization of the vertebral bodies to allow them to get back to their normal shape. In retrospect, conservative treatment can affect appropriate fixation of the affected segment of the spinal column. Apart from this, immobilization increases the risk of kyphotic deformity and chronic pain syndrome and in some cases the symptoms may even get worse. Hence if the patient does not show appropriate response to treatment and the symptoms do not improve even after about six weeks of treatment then other modes of treatment need to be considered and that will be in the form of surgery. If Spondylodiscitis is diagnosed early then the chances of a full recovery are bright rather than when the diagnosis is made late. Another mode of conservative treatment is extensive physical therapy along with use of NSAIDs for pain relief. The physical therapist plays a major role in shaping up a treatment plan and formulates the set of exercises for speedy recovery. Some of the set of exercises useful for Spondylodiscitis are muscle coordination exercises along with increasing stability of the back which can go a long way in helping patients with Spondylodiscitis.
Surgery For Spondylodiscitis
In case if conservative treatment for Spondylodiscitis fails to provide adequate relief then surgery may be required to correct the defect, especially the kyphotic deformity. There are numerous surgical procedures that can be performed for correcting the defects caused by Spondylodiscitis. The appropriate surgical procedure depends upon the segment of the vertebral body affected. The most suited approach is the anterior approach which gives the best view of the affected area. A posterior decompression needs to be avoided in cases of Spondylodiscitis as it may lead to spinal instability. Anterior decompression with an autologous bone graft or even a titanium cage to correct the defect has also been shown to be useful. The most novel approach towards surgical treatment for Spondylodiscitis is the use of human bone morphogenetic protein. In some cases minimally invasive procedures like the percutaneous transpedicular discectomy has been shown to be extremely effective in about 80% of cases of Spondylodiscitis if it is diagnosed early. The above surgical measures are only used in case if physical therapy, antibiotics and other forms of conservative treatments do not provide adequate relief from Spondylodiscitis.