Discitis

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  1. Primary symptom is local moderate to severe pain exacerbated by any movement of the spine with radiation to abdomen, hips, leg, scrotum, groin or perineum; fever and chills are common but not uniformly present
  2. Characteristic radiographic finding that helps distinguish infection from metastatic disease is that destruction of the disc space is highly suggestive of infection, whereas tumor will not cross the disc space
  3. Gadolinium enhancement of the vertebral bone marrow or posterior annulus fibrosus is highly suggestive of a discitis; enhancement of the disc space is common but not as specific for discitis
  4. Pathogens:
    1. S.aureus most common; S.epidermitis is most common pathogen post-operatively
    2. post-operative discitis may occur up to 8 months after surgery
    3. ESR is almost always elevated and is a good indicator of treatment efficacy
  5. Treatment: antibiotics and/or surgery when diagnosis is uncertain or decompression of neural structures is indicated
    1. most patients will obtain a bony fusion and become pain free eventually
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