A case ascertainment study of septic discitis: clinical, microbiological and radiological features
Q J Med 2001; 94: 465-47 N. Hopkinson, J. Stevenson1 and S. Benjamin
We studied the spectrum of septic discitis presenting to two busy district general hospitals over 2.5 years (November 1996 to April 1999), surveying the case notes of all patients attending Royal Bournemouth and Poole Hospitals with probable septic discitis on magnetic resonance imaging (MRI). Twenty-two cases of septic discitis were identified, suggesting an annual incidence of 2/100 000/year. Seventy-three percent of patients were aged 65 years. In 91% of patients, back pain was the presenting symptom, with neurological signs evident in 45% of patients. Fever>37.5 °C was present in 68% of patients, and a marked elevation of erythrocyte sedimentation rate (ESR) in 91%. Diagnosis was originally by MRI in 86% of patients, with plain radiographs not diagnostic of discitis in the early stages of the infection. Staphylococcus aureus was the commonest pathogen (41%), but in 18% of patients, no organism was identified. The major predisposing factors to septic discitis were invasive procedures (41%), underlying cancer (25%) and diabetes (18%). Pre-existing degenerative spinal disease was found in 50% of patients. Four patients whose causative organism was not isolated had a poorer outcome: one death and three with increased morbidity. Our estimated incidence rate (2/100 000/year) is higher than that in previous studies and may be due to a higher detection rate with MRI and/or a genuine increase in the number of cases. Septic discitis should be considered in any patient who has severe localized pain at any spinal level, especially if accompanied by fever and elevated ESR, or in the immunosuppressed.

J Am Acad Orthop Surg, Vol 11, No 6, November/December 2003, 413-420.
Childhood Diskitis Sean D. Early, MD, Robert M. Kay, MD and Vernon T. Tolo, MD
Childhood diskitis may occur in the thoracic, lumbar, or sacral spine and can affect children of all ages, but it is most common in the lumbar region in children younger than 5 years. Physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome, and proper use can prevent unnecessary invasive intervention. Presentation varies with age; the child may refuse to bear weight on the lower extremities or may present with back pain, abdominal pain, a limp, or, if an infant or toddler, with irritability. The etiology appears to be a bacterial infection, usually caused by Staphylococcus aureus. Most children improve rapidly with a 4- to 6-week course of antibiotics. Although not routinely necessary, immobilization decreases symptoms and, in the case of osseous destruction, prevents progression of spinal deformity. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics. Follow-up should include plain radiographs at regular intervals for 12 to 18 months to ensure resolution of the destructive process.

LearningRadiology.com Notes & images on these subjects

PEDIATRICS Vol. 105 No. 6 June 2000, pp. 1299-1304
Discitis and Vertebral Osteomyelitis in Children: An 18-Year Review
Marisol Fernandez, MD*, Clark L. Carrol, MD, and Carol J. Baker, MD*
Conclusion. This comparative study suggests that age and clinical presentation distinguish most patients with discitis from those with vertebral osteomyelitis. Although radiographs of the spine usually are sufficient to establish the diagnosis of discitis, MRI is the diagnostic study of choice for pediatric patients with suspected vertebral osteomyelitis. Key words: discitis, vertebral osteomyelitis, children.

2 synonyms or equivalents were found. Discitis (diskitis) aka/or Spondylodiskitis
Discitis: Definition(s) via UMLS - "Inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined as a nonbacterial inflammation and has been attributed to aseptic processes (e.g., chemical reaction to an injected substance). However, recent studies provide evidence that infection may be the initial cause, but perhaps not the promoter, of most cases of discitis. Discitis has been diagnosed in patients following discography, myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. Discitis following chemonucleolysis (especially with chymopapain) is attributed to chemical reaction by some and to introduction of microorganisms by others."

Discussion & Images
History: Patient presents with back pain
-Factoid Discussion: Hematogenous seeding of infection occurs in the vertebral body, especially near the endplates which have the highest blood supply. Osteomyelitis may also develop. Pyogenic infection may break through into the disc. There may be extension into the paraspinous soft tissues. The most common organism is Staphylococcus aureus but other organisms include; Salmonella, Escherichia coli, tuberculosis and brucellosis. Risk factors include diabetes and genitourinary infection. Destruction of bone and disc leads to pain, spinal instability, kyphosis and loss of height. Paraspinous abscess may also result. An epidural abscess may lead to spinal cord compression and neurologic impairment.

Radiology case 336-2116

Article by Jallo & Marcovici
Diskitis (discitis) is an inflammation of the vertebral disk space often related to infection. Infection of the disk space must be considered with vertebral osteomyelitis, as these conditions are almost always present together and share much of the same pathophysiology, symptoms, and treatment. Although diskitis and associated vertebral osteomyelitis are uncommon conditions, they are often the causes of debilitating neurologic injury. Unfortunately, morbidity can be exacerbated by a delay in diagnosis and treatment of this condition. The lumbar region is most commonly affected, followed by the cervical spine and, lastly, the thoracic spine.

Age and Ageing, Vol 29, 454-456, Copyright © 2000 by British Geriatrics Society
Case report. Infective discitis as an uncommon but important cause of back pain in older people
V Goel, J Young and C Patterson
Case reports. Two elderly patients (aged 70 and 80 years) presented with severe back pain and restriction of spinal movements. Inflammatory markers were raised and in each case computed tomography findings confirmed infective discitis. One patient improved with antibiotics but the second developed paraplegia, a recognized complication of discitis.Conclusion. The association of back pain, restricted spinal movements and raised inflammatory markers should act as 'red flags', alerting the clinician to the presence of serious, but potentially treatable pathology.Keywords: back pain, infective discitis, inflammatory markers

N. Talsania, O. A. Ogundipe: Infective Discitis Mimicking Infective Endocarditis and Osteoarthritic Back Pain. The Internet Journal of Rheumatology. 2005. Volume 2 Number 1. (full text)
Abstract
The case of a 76 year old lady with bacteraemia and persistent back pain is presented. Due to the presence of notable co-morbidities, she was initially managed as a case of possible infective endocarditis and severe osteoarthritis of the lumbar spine but subsequently found to have infective discitis. Both infective endocarditis and infective discitis represent conditions that require a high index of suspicion, early diagnosis and institution of appropriate management so as to prevent the development of potentially serious complications. A discussion on the evaluation of patients with infective discitis is presented highlighting some potential pitfalls and diagnostic cautions for the clinician.

General Principles in the Medical and Surgical Management of Spinal Infections: A Multidisciplinary Approach Neurosurg Focus 17(6)
Alfredo Quiñones-Hinojosa, M.D.; Peter Jun, M.D.; Richard Jacobs, M.D.; William S. Rosenberg, M.D.; Philip R. Weinstein, M.D.
Abstract
Object: Infections along the spinal axis are characterized by an insidious onset, and the resulting delays in diagnosis are associated with serious neurological consequences and even death. Infections of the spine can affect the vertebral bodies, intervertebral discs, spinal canal, and surrounding soft tissues. Neurological dysfunction occurs when the spinal cord becomes compressed, edematous, or ischemic due to compression by abscess or vascular compromise. The aim of this paper was to detail general diagnostic and management principles for this disease.
Methods: Recent progress in medical technologies, including the development of potent antimicrobial drugs, advanced imaging, and improved surgical methods, have dramatically reduced morbidity and mortality rates for spinal infections; however, debate still exists on the proper management of this disease. In this paper, the authors review the current management protocols for spinal infections at their institution, focusing on medical and surgical treatments for vertebral osteomyelitis, intervertebral disc space infections, and spinal canal and soft-tissue abscesses.
Conclusions: Technological advances in imaging modalities, pharmaceutics, and surgery have resulted in excellent outcomes and have greatly reduced the morbidity and mortality rates associated with spinal infections. Currently, treatment of spinal infections requires a multidisciplinary team that includes infectious diseases experts, neuroradiologists, and spine surgeons. The key to successful management of spinal infections is early detection.

Discussion: - a benign, self-limiting inflammation or infection of an intervertebral disc space or a vertebral end-plate; - it may represent extension of subacute vertebral endplate osteomyelitis which does not produce a progressive vertebral osteomyelitis; - discitis presents in different ways at different ages; - in adult disc space usually goes on to fusion, where as in child disc space is usually restored; - can be difficult to diagnose in the uncommunicative child of one to three years of age

Post-operative discitis
acute infections usually occur between 1-2 wks after surgery; - pt who has recently undergone excision of a herniated disc and who presents with localized back pain and spasm following a relatively pain free interval should be suspected; - when infection has involved disc space in the postoperative setting, 40% spontaneous fusion can be expected at 2 year follow up

Postprocedural discitis is an infection in the vertebral disc space that may occur following any invasive procedure of the spine, especially those in the low back, and can be difficult to diagnose. The vertebral disc is the soft cushioning material that lies between the bones (called "vertebrae") of the spine. The soft, inner portion of the disc (called the "nucleus pulposus") can become infected following any spinal procedure including all open and minimally invasive surgeries and/or injections into the disc space. The infection can spread from the inner portion of the disc to the tougher outer portion (called the "annulus fibrosis") and into the vertebral bone.

Scott M.W. Haufe, Anthony R. Mork: Prevalence of Discitis post Lumbar Endoscopic Discectomy. The Internet Journal of Spine Surgery. 2005. Volume 1 Number 1.
Results: 3 out of 109 patients developed discitis. 2 patients did not receive preoperative antibiotics and one patient did receive preoperative antibiotics. Conclusions: Discitis after lumbar endoscopic discectomies occurs in 2-3% of patients. Preoperative antibiotics may offer some assistance in reducing the overall rate of infections but a larger sampling is needed to confirm this claim