yoga book / pathologie / spondylodiszitis

Definition

Spondylodiscitis is an inflammation of the intervertebral discs, the adjacent vertebral bodies and the neighbouring soft tissue, which is usually caused by bacteria, predominantly staphylococci (Staphylococcus aureus: 90 %) or secondarily streptococci, rarely also by tuberculosis. The incidence is 5-6 / 100,000 patient years. Factors such as previous surgery, age, diabetes mellitus, sepsis and immunodeficiency can increase the risk by a factor of up to 3.5. The peak age is 50-70 years and the incidence mainly affects the lumbar spine.

The majority of cases are based on haematogenous transmission, with the subchondral bone being affected first, followed by infection of other tissue via the intervertebral arteries. A per continuitatem, i.e. from a neighbouring focus of infection to a paravertebral abscess, is rather rare, as are iatrogenic cases (lumbar puncture, surgery) or infection in the context of open trauma. Lymphogenic transmission is also possible. The underlying primary infections are often localised in the UGT, GIT or respiratory tract.

ICD

M46.49

Ursache

1. hämatogene oder lymphogene Streuung eines Primärinfekts
2. iatrogen
3. open-traumatic

Predisposing

1. Previous operations
2. Alter
3. Diabetes mellitus
4. Sepsis and immunodeficiency
5. Alcohol speciality
6. Long-term corticosteroid therapy

Diagnose

1. X-rays may still be unremarkable 2-8 weeks after infection, after which irregularities can be seen in the upper and lower plates of the vertebral bodies, the intervertebral discs may appear reduced in thickness, signs of osteolysis
2. CT is conspicuous earlier than X-ray
3. MRI is only inconspicuous in the early phase, therefore repeat after one week if suspected

Symptome

1. Pressor tenderness and palpitations over the affected segment
2. Rest pain over the affected segment
3. Night pain
4. Painful movements, especially with rotations of the spine
5. General feeling of illness
6. B symptoms: fever, night sweats, unintentional weight loss
7. with epidural spread: bilateral sensory disturbance or leg paralysis

Therapie

1. Immobilisation, orthosis
2. Antibiotics (weeks to months)
3. Debridement if necessary
4. ggf. Spondylodese

Complications

1. Abscess with compression of the spinal cord and neurological symptoms
2. Vertebral body deformations, instability of the spine

DD

1. Fractures
2. Osteoporotic fractures, sintered fractures
3. Ankylosing spondylitis
4. Scheuermann’s disease
5. RA
6. Vertebral body tumours and metastases

External links

https://register.awmf.org/de/leitlinien/detail/151-001