Jul 16

Discitis And Vertebral Osteomyelitis

The infection that affects the discs is called discitis. This disease is also referred to as “vertebral osteomyelitis.” This is because the bone of the vertebrae surrounding the disc is infected (osteomyelitis means infection in the bone). It is a potentially very serious injury that needs to be detected as soon as possible.

I have back pain, how do I know if it is a discitis?

Some symptoms of discitis are framed within what doctors call “red flags.” These are symptoms that put us on the alert that there may be something serious. These types of symptoms appear later and may delay the diagnosis. Let’s see how the symptoms progress.

The main symptom is pain. It is a pain that appears suddenly, without falls, accidents or other causes. In principle, if we fall and our neck hurts, we will not think of a disicitis. In a pain that appears slowly and that is becoming more and more serious. It depends on where the infection is, it will hurt your neck or back. The pain we notice in the affected area and is very typical that increases much with the movements. The patient with discitis calls attention to how sensitive it is to the mobilization or palpation of the injured region. This progression of pain can last for weeks, are not “fast” infections usually. On many occasions the pain is worse at night. This is one of the red flags that forces doctors to further study the injury.

When the pain appears in the context of an infection in the blood or an endocarditis makes us suspect. Fever is a warning symptom but we will not find it in all patients, only some will suffer.

In the cases that progress a lot we can find more serious symptoms. It occurs when the infection spreads and occupies the spaces of the nerves and marrow. It will produce symptoms such as lack of sensitivity and paralysis. Do not be scared, it is very difficult to reach these symptoms without having previously had an invalidating pain. This pain causes us to make the diagnosis before reaching such complications.

Discitis And Vertebral OsteomyelitisIf I have these symptoms, how will my doctor know if I have discitis?

The most important thing, as almost always, is an adequate evaluation in the consultation. Once the injury is suspected our doctor has several alternatives:

– A simple blood test can give us clues to the infection because what doctors call “acute phase reactants” will be altered. They are parameters that are altered with certain diseases. Leukocytes (white blood cells) that are responding to infection may also be high.

– We can also perform blood and urine cultures in search of the responsible bacteria to be able to guide the most appropriate treatment.

– The imaging tests will help us to see the images of the lesion. The most useful are MRI and CT.

– Sometimes it may be necessary to take a sample directly from the infected area. This biopsy is done with a needle that we guide with the scanner.

How could I have a discitis if I have not done anything?

The vast majority of the time the infection reaches the vertebrae through the blood. That is, it travels from another part of the body where there is infection. It does it through the bloodstream, mixed with our blood. And where does the infection come from? It can be from many places, we seldom know where it came from. From an infection of a tooth, an infected wound or an infection of the respiratory tract, for example.

There are also other ways to get infected. Infiltrations and surgeries are an entry way that bacteria can use to reach the back.

Infection in people older than 50 is more typical. It is these people the arteries that go to the vertebrae are more aged. This makes it more likely that the bacteria will stay there anchored when traveling through the blood. A curious fact is that they are twice as frequent in men as in women.

We must take into account that there are groups of people with more predisposition such as diabetics, back operated as we said or those who suffer some type of immunosuppression (low defenses). This lowering of defenses can also be seen in people taking corticosteroids.

What is the treatment of discitis?

As it is a bacterial infection, a fundamental treatment will be based on antibiotics. The treatments are long, probably with a minimum of six weeks of medication.

The surgery will be necessary in some cases to clean the infected area. This treatment will be mandatory when major structures such as the spinal cord are being damaged. Also when we do not get better with the medication.

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