Diseases

Spondylodiscitis - symptoms, causes and treatment

Spondylodiscitis - symptoms, causes and treatment


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Inflammation of the vertebrae and intervertebral discs

Spondylodiscitis is a mostly bacterial inflammation of the intervertebral discs, which also spreads to the two surrounding vertebral bodies. There are different symptoms depending on the severity and location, mostly accompanied by back pain. The diagnosis of this serious illness is often made relatively late, so that essential therapeutic measures, such as antibiotic treatment and possibly also surgery, often only take place at an advanced stage. In many cases, residual damage to the spine remains.

A brief overview

Inflammation of the intervertebral disc and vertebral bodies is a serious illness that needs immediate treatment to prevent possible consequential damage. In the short summary, read the most important facts about spondylodiscitis and find out more in the following article.

  • definition: Spondylodiscitis is an inflammation that primarily affects the intervertebral discs and spreads to the two adjacent vertebral bodies. The term discitis, which describes an isolated inflammation of the intervertebral disc, is also often used synonymously.
  • Symptoms: Depending on the location and characteristics, back pain or radiating pain in the spine develops, which can be accompanied by fever and other signs of inflammation. Restrictions on movement, sensory disorders and a certain weakness (including muscle weakness) are also possible complaints.
  • causes: In most cases, a staph infection is responsible for the inflammation. But other pathogens or autoimmune diseases can also cause spondylodiscitis.
  • diagnosis: In order to be able to make the diagnosis, detailed images of a magnetic resonance tomography must be evaluated in the event of suspicious moments. Complementary blood tests and possibly a pathogen determination are part of the test before and during treatment.
  • treatment: In most cases, intensive antibiotic therapy is essential. In the case of severe courses and complications, a surgical procedure to remove the infected structures is also carried out. A longer immobilization and gradual regeneration and stabilization of the affected spine segment is an important part of the therapy.
  • Naturopathic treatment: Various complementary measures from the field of naturopathy and alternative treatment methods can, in coordination with the necessary conventional medical therapy, support the healing process by activating the body's own defenses.

Definition

Spondylodiscitis is an inflammation that primarily affects the intervertebral discs and spreads to the two adjacent vertebral bodies as the process progresses. A distinction is to be made between spondylitis, an infection that, however, arises from the vertebral bodies and passes to the intervertebral discs (osteomyelitis of the spine) and discitis, a rarely occurring isolated disc inflammation. Spondylodiscitis is also often used synonymously for discitis, since in most cases inflammation of the intervertebral discs also spreads to the vertebrae.

The disease is one of the inflammatory spondylopathies in the group of spinal and back diseases, which are not specified. Strictly speaking, in medical terminology, the word spondylus refers to the vertebra and the word discus (discus intervertebralis) to the intervertebral disc. The ending syllable -itis indicates the inflammatory character of a disease.

The disease can occur at any age, but such an illness increasingly occurs from the age of fifty and more often in men than in women.

Symptoms

The complaints depend on the severity and the location of the inflammation. The symptoms are often not very characteristic, but back pain occurs in the vast majority of cases. The pain in the back tends to be local and sudden (acute), often also at rest or at night. Since it is an inflammation, flu-like symptoms may also occur, with fever, chills, night sweats and general fatigue.

Sensation disorders, weakness (including muscle weakness) and stiffness in the back can also occur. These symptoms are more likely to be associated with nerve damage. Depending on the starting point, the back pain can also radiate and be perceived similarly to a herniated disc. Flank pain or sciatic pain is often described. In addition, tensions, such as neck tension, can develop and cause further muscular discomfort.

Causes

Most often, the inflammation is caused by the bacterium Staphylococcus aureus causes that immigrates from another infected region in the organism (endogenous infection). However, the infection can also result from spinal disc surgery or from open injuries. Other bacteria and fungi (very rarely only parasites) have already been identified as the cause of the disease. This inflammation is also called unspecific spondylodiscitis.

In rare, specific spondylodiscitis, the tuberculosis pathogen affects the bones and joints in the area of ​​the spine Mycobacterium tuberculosis the speech (skeletal tuberculosis). This disease always develops on the endogenous route of infection.

If there is an bacterial inflammation, other underlying diseases, so-called autoimmune diseases, are the cause of the disease. For example, ankylosing spondylitis (ankylosing spondylitis), a chronic inflammatory rheumatic autoimmune disease that primarily affects the tendons and joints of the spine, can also lead to inflammation of the intervertebral disc and vertebral body.

There also appear to be generally favorable factors for the development of spondylodiscitis. These include, for example, excessive alcohol consumption, obesity, heart diseases (cardiovascular diseases) and diabetes mellitus.

Diagnosis

It is not easy to differentiate between the various diseases and forms of inflammation in the spine and usually requires extensive research. At the very beginning, the patient's medical history should be asked whether other drugs have immunosuppressive drugs. Because immunosuppressive drugs or a generally poor general condition favor bacterial inflammatory processes.

In the clinical examination, the exact origin and character of the pain that arises is usually analyzed and other possible complaints, such as restricted movement, are also examined more closely. In order to rule out diseases with a similar clinical picture (differential diagnosis), neurological examinations are also used.

In the case of suspected spondylodiscitis, radiological examinations as in other spinal disorders (X-rays, magnetic resonance imaging (MRI) and computed tomography) are always carried out. The best way to identify the corresponding pathological changes on MRI images using contrast media. Depending on the stage of the disease, a decrease in the height of the diseased intervertebral discs can be seen (compression of the cartilage discs) and various bone damage, similar to osteolysis. Sometimes it is also possible to detect abscesses due to the infection (paravertebral or epidural abscesses) or to detect an infestation of the spinal space.

Additional laboratory tests of a blood sample should be part of the diagnosis, particularly with regard to various inflammation parameters. A further germ analysis by blood culture or biopsy is often necessary in order to be able to determine the appropriate treatment procedure.

Treatment

Inflammation in the area of ​​the intervertebral disc and vertebral body are often only recognized and treated late. A diagnosed spondylodiscitis should be taken very seriously by the person affected and the treating person and appropriate medical treatment should be initiated immediately. Untreated, the bacterial infection can spread to other neighboring regions and quite often leads to serious and protracted complications up to life-threatening conditions.

In most cases, conservative, drug therapy, which consists of the intravenous administration of antibiotics, is essential. An inpatient hospital stay is usually necessary during this treatment. If the duration of the therapy is longer, it may be possible to switch to oral administration, which can sometimes be continued in an outpatient treatment.

The immobilization of the affected spinal area is also an integral part of a successful therapy. For this, trunk orthoses are used and a strict bed rest over several weeks is required in many cases.

If there is no bacterial inflammation, but an infection by fungi or other pathogens, antimycotic (or in exceptional cases, antiparasitic) therapy must be given. If a specific infection is proven, rapid anti-tuberculosis therapy is required.

In serious and high-risk cases (emergencies), which are associated with neurological deficits or sepsis, for example, a surgical procedure may be necessary and may offer the only chance of survival. Infected structures are removed, for example by means of a discectomy (removal of the intervertebral disc tissue) and subsequent blocking of the two surrounding vertebral bodies. Abscess drainage and other invasive measures may also be required. Usually such an operation is followed by a longer antibiotic therapy and postoperative mobilization (exercise therapy) is of great importance for regeneration.

It is not uncommon for both the antibiotic treatment and the operative therapy to have residual complaints that are due to various irreversible damage to the adjacent segments after the inflammation has healed. Most often, sufferers suffer from neurological or motor deficits of varying degrees. In the further healing process, however, improvements can still be achieved that increase the quality of life accordingly.

Naturopathic and complementary treatment

With inflammation and bacterial infections, there are many natural therapies and natural remedies that relieve symptoms and help prevent further spread. In the case of spondylodiscitis, as with other serious inflammations, traditional medical treatment is recommended.

To support antibiotic therapy or in the postoperative process, medicinal plants with anti-inflammatory and antibacterial effects (for example angelica, arnica, devil's claw or tin herb) can also be used under medical and therapeutic advice.

The complementary method of mistletoe therapy is also known for a better regeneration ability of the immune system after operations. However, this method, like hyperbaric oxygen therapy (HBO therapy) to prevent the spread of infection, is still controversial.

When it comes to strengthening the immune system, methods such as autologous blood and urine therapy as well as thymus therapy can also be used. In this context, various home remedies, homeopathic remedies or Schüßler salts are often used. In any case, a healthy nutrient balance should be established for an optimal recovery. (tf, cs)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • German Society for Rheumatology (DGRh): S3 guidelines for axial spondyloarthritis including ankylosing spondylitis and early forms, as of November 2013, detailed view of the guidelines
  • German Society for Orthopedics and Orthopedic Surgery (DGOOC): S2k guideline for specific low back pain, as of December 2017, detailed view of guidelines
  • Grifka, Joachim (ed.), Kuster, Markus (ed.): Orthopedics and trauma surgery, Springer, 2011
  • Diagnostics of degenerative spinal disorders. The Radiologist, Volume 51, Edition 09/2011, pp. 761-762.
  • Sobottke, Rolf / Seifert, Harald / Fätkenheuer, Gerd / u .: Current diagnosis and therapy of spondylodiscitis, Federal Medical Association and National Association of Statutory Health Insurance Physicians, 2008, aerzteblatt.de
  • Merck & Co., Inc .: Ankylosing spondylitis (accessed: June 25, 2019), msdmanuals.com
  • Herold, Gerd, Internal Medicine 2019, self-published, 2018

ICD codes for this disease: M46ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Spinal Infections. Definition (October 2022).