1. بسم اللّه الرحمن الرحیم

2. INFECTIOUS SPONDILODISCITIS

3. Definition
Infection of intervertebral disc and adjacent vertebrae

4. Microbial Agents Pyogens (Staph -E coli) Acute
Brucella- Salmonella Subacute
Tuberculosis Chronic

5. PATHOGENESIS

6. Hematogenous
Direct
inoculation
Adjacent tissue

7. ANT
POST
Spinal artery

8. ANT
POST
INITIATION

9. ANT
POST
INITIATION
DESTRUCTION

10. TUBERCULOSIS
BRUCELOSIS
Anterior
DESTRUCTION

11. Anterior
REPAIR

12. COURSE
ANT
INITIATION
DESTRUCTION
REPAIR

13. SPONDYLODISCITIS OF TUBERCULOSIS (POTT’S disease)

14. Epidemiology 2 % musculoskeletal Site: Lung involvement: 20-30%
1% spine
Site:
Upper thoracic: Children
Lower thoracic: Adult
Lung involvement: 20-30%

19. Clinical Manifestation

20. Clinical Manifestation
STAGE 2
(DESTRUCTION)
months
1-2 years
STAGE 1
(INITIATION)
STAGE 3
(REPAIR)

21. Clinical Manifestation
STAGE 1
(INITIATION)
Mechanical pain
Mild tenderness

22. Clinical Manifestation
STAGE 2
(DESTRUCTION)
STAGE 1
(INITIATION)
months
Constitutional
Severe Back pain
Ph/Ex:
Severe Tenderness
Blockage (erect posture)
Gibbous deformity
Cold abscess
Neurological (paraplegia)

23. Clinical Manifestation
STAGE 2
(DESTRUCTION)
STAGE 1
(INITIATION)
1-2 years
STAGE 3
(REPAIR)
Mechanical pain
Reduce symptom
Reduce spasm

24. DIAGNOSIS

25. IMAGING

28. RADIOGRAPHY

31. LAB TESTS

32. LAB TESTS ESR PPD (+) Sputum smear & culture
Abscess or bone biopsy: Culture / Pathology

33. TREATMENT

34. TREATMENT Medical: Mainstay of treatment Alone is successful in 70%
Duration: 18 m (9-12 m ?)

35. TREATMENT Surgical: Advanced neurological deficit
Progressive Neurological deficits
Kyphosis > 40 degrees

36. Monitoring Clinical Radiology ESR, CRP pain constitutional mobility
neurological signs
ESR, CRP
Radiology
may be progress during first 6 month of treatment

37. BRUCELLOSIS SPONDYLODISCITIS

38. EPIDEMIOLOGY
Spine:
7-8% of skeletal
Site:
Lumbosacral (Anterior)

39. BRUCELOSIS

40. CLINICAL MANIFESTATION

41. CLINICAL MANIFESTATION
Constitutional:
Fever
Night Sweat
Malaise
Arthralgia
Apathetic
Then: Severe low back pain

42. CLINICAL MANIFESTATION
Physical examination:
Blockage
Severe tenderness
Fever
Splenomegaly
Lymphadenopathy

43. DIAGNOSIS

44. DIAGNOSIS Clinical presentation Radiography
Supporting laboratory finding
History of potential exposure:
Endemic area
Microbiology laboratory
Unpasteurized milk products
Contact with animals
History of similar illness in the family (documented in almost 50% of cases).

46. Laboratory WBC: NL or low ESR, CRP: NL Wright; Cooms Wright
B/C or Bone marrow culture (7-35 d)
ELISA

47. Treatment 2 Drug: 3 months Rifampin 600-900 mg/d
Doxycycline 100 mg twice daily
3 months

48. SALMONELLA SPONDYLODISCITIS

49. SALMONELLA SPONDYLODISCITIS
Clinical sign & radiologic future is similar to Brucellosis.
Diarrhea: 60%
Positive S/C (most commonly)

50. SALMONELLA SPONDYLODISCITIS
Treatment:
Quinolones
Ceftriaxone
For 4 w

51. PYOGENIC SPONDYLODISCITIS

52. PYOGENIC SPONDYLODISCITIS
staphylococcus aureus (50 – 70%)
History of recent infection (UTI; septicemia)
Acute severe back pain; High fever; Chills
Patient is ill.
Blockage; Severe tenderness
Lumbar spine (45%) Thoracic (35%)

53. PYOGENIC SPONDYLODISCITIS
Radiography:
severe destructive
rapidly progressive lesion
Large bone bridge

54. PYOGENIC SPONDYLODISCITIS
MRI:

55. PYOGENIC SPONDYLODISCITIS
Laboratory:
Leucocytosis
ESR (useful in fallow up)
Culture
B/C: 50% - 70%
Biopsy: 70% - 90%
UTD 19.3

56. PYOGENIC SPONDYLODISCITIS
Diagnosis:
Clinical presentation
Radiology
laboratory

57. PYOGENIC SPONDYLODISCITIS
Treatment:
Two drugs (Staph & gram negative organisms)
Six weeks
Surgery:
- progressive
- cord compression

59. Paravertebral abscess Psoas abscess
Brucellosis
Tuberculosis
Site
Lumbar and others
Dorsolumbar
Vertebrae
Multiple or contiguous
Contiguous
Diskitis
Late
Early
Body
Intact until late
Morphology lost early
Canal compression
Rare
Common
Epiphysitis
Anterosuperior (Pom's sign)
General: upper and lower disk regions, central, subperiosteal
Osteophyte
Anterolateral (parrot beak)
Unusual
Deformity
Wedging uncommon
Anterior wedge, gibbus
Recovery
Sclerosis, whole body
Variable
Paravertebral abscess
Small, well-localized
Common and discrete loss, transverse process
Psoas abscess
More likely