Discitis or diskitis is an infection in the intervertebral disc space that affects different age groups. In adults it can lead to severe consequences such as sepsis or epidural abscess but can also spontaneously resolve, especially in children under 8 years of age. Discitis occurs post surgically in approximately 1-2 percent of patients after spinal surgery.

1. Discitis or Diskitis
Discitis or diskitis is an infection in
the intervertebral disc space that affects different
age groups. In adults it can lead to severe
consequences such as sepsis or epidural
abscess but can also spontaneously resolve,
especially in children under 8 years of age.
Discitis occurs post surgically in approximately 1-
2 percent of patients after spinal surgery.

3. Symptoms include severe back pain, leading to lack of mobility.
Some very young children may refuse to walk and arching of the
back is possible. In post-operative situations, the symptoms
occur within a week and result in severe low back pain or neck
pain (depending on the surgical location). If untreated, the
discitis may resolve on its own, causing spontaneous fusion of
the intervertebral disc space, cause a chronic low grade
infection, or progress to osteomyelitis and possibly even
an epidural abscess. In case of concomitant inflammation of one
or more vertebrae (in such cases usually the areas adjacent to
the intervertebral disc spaces), the condition is
called spondylodiscitis.

4. There is debate as to the cause, although hematogenous seeding
of the offending organism is favored as well as direct spread. It is
important to differentiate between spontaneous discitis which is
usually from hematologic spread from a urinary or respiratory
infection versus that from a post-operative complication which
usually involves skin flora such as staph aureus. It can be caused
due to spinal tuberculosis and spread along spinal ligament to
involve the adjacent anterior vertebral bodies, causing
angulation of the vertebrae with subsequent kyphosis.

5. Diagnosis is usually apparent on MRI although plain X-rays
and CT examinations can be suggestive. The MRI will reveal air
changes in the disc and possibly even external involvement
involving the bone or epidural regions. A biopsy may be
performed and helps with diagnosis in some cases but often an
organism is not obtained. C-reactive protein levels and ESR
levels will be elevated and are useful for treatment. Often,
the white blood cell count will be normal and the patient will
be afebrile.

6. Treatment usually includes antibiotics, and reducing the mobility
of the affected region, either with a back brace or a plaster cast.
Without treatment, the patient may form an abscess which may
need to be surgically corrected. Due to the poor vascularity of
the disc, drugs required for treatment often include potent
agents such as Ciprofloxacin along with Vancomycin.
Occasionally, oral drugs can be used to treat the infection but it
may fail and IV drugs may be required.
If the patient is an adult many surgeons and doctors now
recommend moving little and often and within the pain limits of
the medication. Discs respond to osmotic pressure therefore
movement is beneficial to increase their blood flow and fluid
dynamics. This is why disc patients are no longer told to bed rest.
In children whether to bed rest or move a little is decided on an
individual basis, depending on the site and severity of the
discitis.

7. An infected disc at the level of C5 C6 causing neurological
symptoms