SPONDYLODISCITIS

Ira Nong
• Spondylodiscitis is a combination of discitis
(inflammation of one or more intervertebral disc
spaces)
• Occurs in 5% to 23% of patients (AS), most
commonly in the lower thorasic spine
 CAUSES

• Spondylodiscitis is believed to arise from a stress

fracture rather than from extension of a localized
inflammatory process.
• Spondylodiscitis is the most common complication of
sepsis or local infection, usually in the form of an
abscess.
– The main causative organisms : staphylococci and
Mycobacterium tuberculosis,
– Spondylodiscitis frequently develops in
immunocompromised individuals, such as by a
cancer, infection, or by immunosuppresive drugs
used for organ transplantations.
 IMAGING

• Conventional x-rays (AP and lateral

views)
• Skeletal scintigraphy
– Since the radiological signs of inflammatory spinal
column destruction are not detectable in the
initial stage, 3-phase skeletal scintigraphy is a
valuable instrument in this initial phase with
which the centers of inflammation can be clearly
depicted early in the process.
• Computer tomography (CT), magnetic
resonance tomography (MRT) with or without a
contrast agent
– These diagnostic methods depict the affected
regions in thin layers, very clearly and in diagnosable
detail.
– Changes in the spongious vertebral tissue,
intervertebral discs, spinal cord and nerves can be
assessed differentially.
– Existing abscesses in the epidural space or in
paravertebral locations can be located so that their
course of development can be followed.
• MRI Features include
– high T2 signal disc
– low T1 signal vertebral bodies
– enhancement of discs and vertebral bodies
– enhancing soft tissue paravertebral mass
– rim-enhancing paravertebral or psoas abscess
– epidural abscess or enhancing tissue
 DIAGNOSIS

• The main methods to diagnose a spondylodiscitis are

MRI, biopsy and microbiological tests such as PCR to
determine an infectious cause
 TREATMENT

• Conservative treatment with : NSAID, rest, physiotherapy

• For persistent symptoms, we can performed pseudoarthrosis
• There is no international standard for surgical
treatment of spondylodiscitis.
• The objectives of surgery are the radical removal
(debridement) of tissue destroyed by the inflammatory
process, and the stable reconstruction of the existing
defect to ensure a functionally satisfactory spine
position.
• Treatment consists of posterior spinal
instrumentation and fusion. Supplemental
anterior column bone grafting is sometimes
necessary.
• Spinal stenosis may develop at the level of
spondylodiscitis. When stenosis is present,
spinal decompression is required in
combination with spinal stabilization and
fusion.
• Different surgical methods are used
depending on which spinal segment is
affected and the specific local findings.
• Surgical access is either ventral (from the
front), dorsal (from the back) or a combination
of the two.
 References
– Benzel, Edward C. Spine surgery: Techniques,
complication avoidance and Management, Vol I.
2nd Edition, 1999
– Solomon, Louis, dkk. Apley’s System of
Orthopaedics and fractures, 9th edition, 2010
– Simeone, Rothman. The Spine Vol I, 6th Edition,
2011
– Devlin, Vincent. Spine secret plus, 2nd Edition,
2012
• THANK YOU