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.