Definition Spondylodiscitis
Spondylodiscitis is a combined bacterial inflammation of a vertebral body (spondylitis) and the adjacent intervertebral disc (discitis). A distinction is made between specific spondylodiscitis and non-specific spondylodiscitis.
- Specific spondylodiscitis is an inflammation (infection) with the tubercle bacterium.
It is a disease pattern that has become rare (skeletal tuberculosis). The disease process is usually gradual and less acute (sudden) than in the unspecific form. The bacteria are metabolized via the bloodstream (hematogenic).
- Non-specific spondylodiscitis is an inflammation that can be caused by all pus pathogens. The most common pathogen is the bacterium Staphylococcus aureus. Due to its much more frequent occurrence, the following article focuses on the presentation of unspecific spondylodiscitis.
Disease development of spondylodiscitis
In spondylodiscitis caused by the bloodstream, the inflammation begins in the end plates of the vertebral bodies. From there it spreads to the intervertebral disc. The speed at which such a spread occurs is related to the number of bacteria responsible for the infection and the patient’s general defense (immune system).
According to the common arterial blood supply, two adjacent vertebral bodies are more often affected by an inflammation at the same time. In severe inflammation, the infection can spread further. If the vertebral canal is reached (epidural abscess), the spinal cord and, due to an ascending infection, the brain are also at risk (meningitis, encephalistis). In the area of the lumbar spine, the inflammation can continue along the psoas muscle (hip flexor) into the thigh (descensus abscess).
Symptoms of Spondylodiscitis
The signs of spondylodiscitis are often easy to confirm retrospectively, but are often very unspecific and vague when they first appear. A strong knocking pain is typical, which is felt exactly above the inflamed vertebrae. Even slight tapping of the affected area causes severe pain.
Rather less frequent is a pressure pain when only touching the skin above the inflammation, nevertheless this can also be the case. The pain is classically dull and boring and is also very strong at night. Besides these triggerable pains, many patients complain about back pain in general.
Even minimal movements – especially bending forward – are very painful. So-called axial loads, such as those caused by climbing stairs, also increase the pain. This results in a stiff posture typical of patients with spondylodiscitis.
If the spinal cord is also affected by the inflammation or if part of the diseased vertebral body shifts there, neurological symptoms such as paralysis, sensory disturbances or sensory deficiencies may also occur. In addition, very general symptoms of disease can be found, especially in chronic spondylodiscitis diseases: Those affected may suffer from fever, night sweats or weight loss without being able to explain the cause. If the disease is finally far advanced, a quite clear symptom is added as a further symptom, which then even allows a gaze diagnosis: In severe spondylodiscitis with large vertebral body destruction, the development of a so-called gibbus can be observed; a very acute-angled hump, which makes the patient walk and stand bent forward.
The most frequent causes of unspecific vertebral body and intervertebral disc inflammation/spondylodiscitis are (1. +2.) the metastasis of bacteria in the vertebral body and intervertebral disc via the bloodstream in the course of blood poisoning (bacteremia, sepsis) and (3.)
the inflammation caused by the physician himself (iatrogenic) due to a spinal intervention.
- Any bacterial inflammation in a patient’s body can theoretically lead to bacterial seeding. Common causes are stomach – intestinal infections (bacterial enteritis), bladder infections (vesiculitis, cystitis) and lung infections (pulmonary infections).
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