Discitis of the spine

In the elderly, infection of the intervertebral disc can occur spontaneously. It may arise from haematogenous spread from a urinary tract infection through the lumbar plexus and com­monly involves Gram-negative organisms. The infection is low grade and insidious in onset. The patient complains of increasingly severe back pain which is also present during the night, not just in the day during activity. The patient may have a low-grade fever and the white cell count and erythrocyte sedimentation rate (ESR) may be raised. The diagnosis can be difficult to make on X-ray because degenerative changes present in the elderly spine may make the char­acteristic signs of collapse of the disc space difficult to spot. However, if the diagnosis is considered, careful scrutiny of the X-rays may show a soft-tissue shadow swelling in the prevertebral space with destruction of the adjacent vertebral body endplates. Needle aspiration under image intensifier will allow the organism to be identified and its sensitivity determined. Treatment with the appropriate antibiotic, initially intravenously and then orally, should cure the condition.