Infectious spondylodiscitis

Definition Infection of intervertebral disc and adjacent vertebrae

Epidemiology * Rare but it,s incidense is inceasing* Men> women Age; > 50 years old 2-7% of patients with osteomyelitis * Smj 2007; 52(4): 53

Hematogenous Direct inoculation Adjacent tissue

Hematogenous spread Spinal artery Venous plexus

Spondylodiscitis Infection Abscess

Bacteriology Staphylococcus aureus Enteric gram-negative bacilli Pseudomonas aeruginosa Candida hemolytic streptococci TB Brucella melitensis common in iran

Clinical presentation Pain Fever, anorexia, weight loss Muscle spasm Tenderness Gibbous Neurologic symptome

Imaging Evaluation Radiography CT MRI Bone scan

Imaging finding Soft tissue edema Disc space narrowing End plate erosion Loss of contour Abscess Gibbus deformity Total sclerosis

Bone marrow edema

Lab test CBC ESR, CRP PPD Wright, vidal Sputum analysis(AFB) Blood culture Bone biopsy

Treatment Medical surgery Unresponsive to medical treatment Large abscess Unstable spine

Spondylodiscitis of TB skeletalTB; 3% to 4% Spine involvment in skeletal TB; 50% to 60% common in thoracolumbar spine Active primary source;< 10% cases