Primary Diagnosis

C5-6 discitis, osteomyelitis and paraspinal/epidural phlegmon resulting in spinal cord compression.

Secondary Diagnosis

C5-6 disc, cervical vertebral body

Diagnosis Discussion

Discitis is inflammation of an intervertebral disk or disk space which may lead to disk erosion. Until recently, discitis has been defined as a nonbacterial inflammation and has been attributed to aseptic processes (e.g., chemical reaction to an injected substance). However, recent studies provide evidence that infection may be the initial cause, but perhaps not the promoter, of most cases of discitis. Discitis has been diagnosed in patients following discography, myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. Discitis following chemonucleolysis (especially with chymopapain) is attributed to chemical reaction by some and to introduction of microorganisms by others. In this case, there was no history of spinal intervention. The most likely source of the infection is a hematogeneous etiology from sepsis. The pathogen in this case was s. aureus, although e. coli and other common bacteria are known to produce this condition. As the infection progressed, it caused destruction of both adjacent endplates as well as the intervertebral disc. The infected material is then allowed access to the paraspinal soft tissues and epidural space. The large inflammatory mass in the paraspinal soft tissues did not force this patient to seek treatment. However, once the epidural component reached sufficient size to compress the cervical spinal cord, the resultant weakness produced in the lower and upper extremities finally forced the patient to seek care. Note that despite the large size of the enhancing inflammatory mass (phlegmon), there is no frank abscess formation. The patient responded to antibiotic therapy and did not require surgical decompression initially.

General Anatomic Area:

Cervical

Secondary Anatomic Area:

C5-6 disc, cervical vertebral body

Disease Category:

Infectious

Contributor:

AE Flanders, MD

Date:

12/01/2003

Difficulty Level:

Easy

Pathology Confirmed?:

Yes
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ACR Category Number:

N/A

Keywords:

infection, spondylitis, osteomyelitis