Discitis is a rare condition, characterised by an infection of intervertebral discs in our spine. These discs seperate our vertebrae; the bones in our spine, and act like a pillow to allow movement, absorb shock and transmit loads through our spinal column. Therefore, infection and subsequent inflammation can result in high levels of discomfort and pain. As these discs receive minimal blood supply, our immune cells and medications have difficulty travelling to the site of the infection, so recovery can be a long process. However, through receiving treatment through a team of qualified health practitioners, full rehabilitation is possible.
Signs and Symptoms
The symptoms of discitis can vary greatly, with pain levels varying from mild discomfort to high levels of pain. The severity is largely dependant on a few factors, including how progressed the condition is (depending on the time to detection), age and immune status. Most common signs and symptoms include:
- Localised neck and/or back pain (depending on the disc infected): Generally, this is a gradual onset that can progress to unbearable, severe levels of pain
- Fever and/or chills
- Loss of appetite and/or weight loss
- Night pain
- Fatigue
- Stiffness / limited range of motion in the neck and/or back
- Neurological deficits: This can include muscle weakness, reduced sensation and impaired reflexes depending on the areas of the body supplied by the specific spinal level affected. However, this is less common
Diagnosis
Diagnosis comprises of a comprehensive medical exam from a registered practitioner, including:
- Blood Tests: Which look specifically at your levels of CRP and ESR. High levels indicate inflammation in the body.
- Magnetic Resonance Imaging (MRI): Which show disc inflammation.
Causes and Contributing Factors
In most cases, the infections are either caused by:
- Contiguous spread: meaning infection spread from an infected area close by e.g an infection of vertebrae (osteomyelitis)
- Hematogenous spread: meaning the infection was spread through the bloodstream from another site of infection e.g pneumonia, urinary tract infections
- Direct inoculation: meaning from direct contact and subsequent infection to the area e.g through spinal injections, diagnostic lumbar punctures or spinal surgeries
Contributing factors include:
- Increased alcohol intake
- Immunocompromised individuals
- Intravenous drug users
- Renal (kidney) dysfunction
- Hepatic (liver) cirrhosis
- Cancer
- Type 2 Diabetes Mellitus
- Autoimmune diseases
- > 50 years old
Prognosis
Prognosis is varying. It largely depends on the severity of the condition, how early it was detected and whether you have other Risk Factors (mentioned above) that can impact your bodies ability to fight infection.
(Samy et al., 2021) strongly recommend that your medical team closely monitor you for a year-post to monitor improvement and deterioration.
Treatment
Medical Treatment
- IV Antibiotics: This is the standard treatment, which will help you fight the infection. This is generally provided at an infusion centre, Hospital In The Home (HITH) or other in-home nursing services. This generally lasts 6 – 8 weeks.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications, such as ibuprofen, may also be prescribed. This can reduce both pain and inflammation, providing relief from pain, stiffness and discomfort.
- Surgery: This is the considered in cases where all other treatment fails or complications arise, such as neurological deficits, spinal instability, or abscess formation (formation of an infection pocket). Procedures may involve debridement (removal) of infected tissue and stabilisation of the spinal column.
Physiotherapy Management
Physiotherapy plays a pivotal role in the rehabilitation of patients with discitis, aiming to restore mobility, strengthen muscules, and enhance functional independence. A comprehensive physiotherapy treatment may include:
- Pain Management: Utilisation of modalities such as manual therapy, bracing and therapeutic exercises to alleviate pain and reduce inflammation.
- Mobilisation Exercises: Gentle, progressive exercises designed to improve spinal flexibility and range of motion, tailored to your tolerance and stage of recovery.
- Strengthening Programs: Targeted exercises aimed at improving strength and stability, to support spinal structures and prevent deconditioning.
- Functional Training: Activities aimed at improving the your ability to perform daily tasks safely and effectively, thereby helping you achieve individualised goals and enhancing quality of life.
Information is provided for education purposes only. Always consult your physiotherapist or other health professional.