Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment

Abstract

Spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies (spondylitis), the intervertebral discs (discitis) and finally - the neighboring neural structures. In most cases the condition is due to a hematogenous infection and can affect all regions of the spinal cord, but it is usually localized in the lumbar area. The most common clinical symptom is a pronounced, constant and increasing nocturnal paravertebral pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The disease course is chronic and the lack of specific symptoms often prolongs the time between its debut and the diagnosis. This delay in diagnosis determines its potentially high morbidity and mortality. Treatment is conservative in cases with no residual neurological symptoms and consists of antibiotic therapy and immobilization. Surgical treatment is necessary in patients with neurological deficit, spinal instability or drug resistance.

Welche Parameter haben Einfluss auf den stationären Verlauf bei Patienten mit Spondylodiszitis?

“…Die Spondylodiszitis wird als Infektion durch Erreger mit Befall der Bandscheibe und mit unterschiedlichem Ausmaß der angrenzenden Wirbelkörper definiert [1][2][3][4][5]. Die Letalität liegt heute immer noch zwischen 2 und 17 % [1,3,4,[6][7][8]. Insgesamt ist die Spondylodiszitis mit einer Inzidenz von 1:100.000 Bewohnern/ Jahr eine seltene Erkrankung [6,[9][10][11].…”

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“…Aneta, et al reported neurological symptoms in 1/3 of the cases and ranged from radicular pain to radicu lopathy (29%) to paresis (2-13%) and cauda equina syndrome. (10%) [48]. Current systematic review demonstrated radicular pain and absence of motor deficit in 32% of patients with neurologic findings.…”

Severity and Outcomes of Neurologic Deficits Associated with Pyogenic Spondylodiscitis: A Systematic Review

“…The infection spreads from the disc space into any available space which explains the frequency of epidural abscess formation in the patients with spondylodiscitis. Another important consequence of the delay in diagnosis of spondylodiscitis is the progresson of bony destruction that leads to progressive destruction of the endplates, the trabecular bone of the vertebra and progressive collapse and segmental kyphosis leading to instability [47,48].…”