Infectious Spondylodiscitis, an Overlooked Cause of Pain: A Review

Abstract

S pondylodiscitis refers to inflammation of the vertebral body and intervertebral discs.The infection arises as osteomyelitis of the subchondral bone and spreads to the intervertebral disc.Spinal infections present with different characteristics and clinical manifestations.These include pyogenic (bacterial), granulomatous (tuberculous or fungal), or parasitic (Echinococcosis) infections.The incidence is increasing with the increase in spinal surgery and the longer life expectancy of elderly patients with chronic diseases. [3]e main pathogenic organisms are staphylococci and Mycobacterium tuberculosis.Staphylococcus aureus is the cause of infection in more than half of the patients. [4]The lumbar region (56%) is most commonly involved, followed by the thoracic region (35%).It is more common in men over the age of 60 years and in early childhood.It can be transmitted by hematogenous spread, contiguous spread, and direct inoculation.The contiguous spread usually occurs after infections of the thoracic and intra-abdominal organs.Risk factors include recent or current diseases, diabetes mellitus, rheumatoid arthritis, steroid use, intravenous drug use, alcohol and substance abuse, and a recent history of surgery. Clinical FeaturesThe major symptoms of spinal infections are pain, fever, and loss of muscle strength.The most common symptom Infectious spondyloarthritis occurs through the transmission of a microorganism by various routes, causing an infection in the spine.It can be diagnosed on any desired MRI based on clinical suspicion in the presence of an appropriate clinical manifestation (fever, pain, loss of strength) along with a significant increase in leukocyte, Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP) laboratory parameters.The definitive diagnosis is made by demonstration of the microorganism in the biopsy material.Since the disease is rare and low back pain is very common in the population, the diagnosis is often missed and delayed. [1]Therefore, it still remains an important cause of comorbidity.Delayed diagnosis of this disease, which can be treated with appropriate antibiotic therapy, may result in disability by causing neurological sequelae. [2]he aim of this review is to provide information about infectious spondylodiscitis at a level to manage the diagnosis, treatment, and follow-up process, to keep this diagnosis in mind in patients with risk factors who present with back pain and local tenderness in the spine, especially in patients from endemic regions of tuberculosis and brucellosis, and to expand the investigation in this direction.