1. Infectious spondylodiscitis

2. Definition
Infection of intervertebral disc and adjacent vertebrae

3. 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

4. Hematogenous
Direct
inoculation
Adjacent tissue

5. Hematogenous spread
Spinal artery
Venous plexus

6. Spondylodiscitis
Infection
Abscess

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

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

9. Imaging Evaluation
Radiography CT
MRI
Bone scan

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

11. Bone marrow edema

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

17. Treatment Medical surgery Unresponsive to medical treatment
Large abscess
Unstable spine

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