Spondylodiscitis (ICD code M46.4) is an inflammation of the vertebrae and intervertebral discs. Treatment with antibiotics is usually sufficient. Sometimes surgery is necessary for treatment.
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The human spine consists of around 33 vertebrae, which are connected to each other by the intervertebral discs. As the coccygeal vertebrae of each person are fused together to varying degrees, the total number of vertebrae varies from person to person.
The intervertebral discs act as a buffer between the individual rigid vertebrae. They ensure that the spine remains flexible and that shocks are absorbed when walking.
Many people are familiar with spinal disorders such as herniated discs or lumbago. Spondylodiscitis is less well known. The term comes from Latin and is made up of the syllables
Spondylodiscitis is therefore an inflammation of the vertebrae and intervertebral discs, i.e. both the vertebrae and intervertebral discs are affected. If only vertebral inflammation is present, it is referred to as spondylitis. In the case of pure inflammation of the intervertebral discs, this is referred to as discitis.
In spondylodiscitis, the vertebral bodies and intervertebral discs are inflamed © bilderzwerg | AdobeStock
Spondylodiscitis is characterized by severe back pain. The disease is accompanied by pain on exertion, which gets worse with movement. The pain in the affected area of the back manifests itself as tapping or pressure pain.
The cause of the pain is often only discovered after the patient has suffered for a long time.
In addition to back pain, some sufferers show general signs of inflammation. They suffer from fever and night sweats and feel unwell. This is usually accompanied by physical emaciation, which in turn causes
as a result.
In advanced stages, neurological deficits such as numbness or paralysis can also occur.
Spondylodiscitis is usually caused by a bacterial infection. In most cases, the bacterium Staphylococcus aureus is the responsible pathogen. However, fungi and viruses can also be the cause of spondylodiscitis.
A basic distinction is made between specific spondylodiscitis and non-specific spondylodiscitis.
Specific spondylodiscitis (also known as skeletal tuberculosis) is caused by tubercle bacilli. It occurs less acutely than non-specific spondylodiscitis and has a more gradual course. The infection occurs via the bloodstream. However, this disease has now become rare in our country.
In addition to the aforementioned Bakerium, all other pyogenic pathogens can also cause non-specific spondylodiscitis. The disease is accompanied by acute pain. The cause of the inflammation can be open bone fractures. Bacteria can enter the body through the wound and thus into the bone.
However, the pathogens can also reach the spine via the bloodstream through inflammation sites anywhere in the body.
Risk factors for the development of spondylodiscitis are
Early diagnosis can significantly improve and shorten the course of spondylodiscitis. If the disease remains untreated, this can result in severe symptoms and even a life-threatening course.
However, treatment with antibiotics is often sufficient. The body can then bring the inflammation under control. Nevertheless, consequential damage often remains: in many people, the intervertebral discs remain damaged and the vertebrae stiffen as the disease progresses.
Treatment of spondylodiscitis initially focuses on containing the pain.
Before the actual treatment, the germ or pathogen spectrum must be identified. This requires a biopsy (tissue sample) or surgery. The biopsy is CT-supported, even if no operation is performed. Whether surgery is necessary for the treatment of spondylodiscitis depends on
and the neurological deficits.
If surgery is performed, the surgeon removes the area of inflammation and stabilizes it. This allows the patient to be mobilized quickly and improves their pain.
Without surgery, the patient is initially recommended bed rest until the pain is under control. Drug therapy with antibiotics is usually carried out for 6 to a maximum of 12 weeks. This eliminates the focus of inflammation and prevents it from spreading to other regions of the body.
If the inflammation is not bacterial, but caused by fungi or other pathogens, antifungal or antiparasitic therapy is required.
In addition to drug therapy, the affected vertebral region must be immobilized. Bed rest and a plaster cast have proven effective for this.
After around 10 weeks, exercise therapy is carefully started in order to stabilize the spine.
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