Spondylodiscitis: Known - Unknown?

Overview

A rare inflammation of the intervertebral disc and adjacent vertebral bodies should be takeninto consideration in patients who complain of severe back pain combined with an elevatedtemperature with or without a neurological deficiency. Spondylodiscitis is as a rule associatedwith an elevated sedimentation rate and concentration of C-reactive protein. Non-specificclinical and laboratory signs with a normal picture for a prolonged period are mistaken fordegenerative or tumourous affections of the spine. By means of MR examination it is possibleto diagnose reliably not only spondylodiscitis but also associated abscesses of nervous structure.Based on results of MR of the spine it is possible to elaborate a suitable therapeutic strategy -conservative or surgical. An early correct diagnosis will prevent serious mechanical or neurologicalcomplications. The authors describe the laborious search for the cause of crucial backpain in the first patient and elucidation of protracted fever in the second patient. In bothinstances the leading symptom was associated by a supplementary clinical attribute - in thefirst case subfebrile temperatures in the afternoon and in the second patient by markedlumbalgia. After initial pain of the left knee, severe backache and fever, the course of the diseasein te two patients was similar. The complicated search to diagnose the two-level spondyldiscitistook 1.5 months. The developed paravertebral abscesses had to be treated by surgery, whiletheir early stages can be successfully treated by antibiotics only.

Key words:
spondylodiscitis - osteomyelitis of the spine - paravertebral abscess - epiduralabscess.