関: diskitis、spondylodiscitis

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/14 10:48:11」(JST)

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Discitis or diskitis is an infection in the intervertebral disc space that affects different age groups, but usually spontaneously affects children under 8 years of age. Nonetheless, discitis occurs post surgically in approximately 1-2 percent of patients after spinal surgery.

Signs and symptoms

Symptoms include severe back pain, leading to lack of mobility. Some very young children may refuse to walk and arching of the back is possible. In post-operative situations, the symptoms occur within a week and result in severe low back pain or neck pain (depending on the surgical location). If untreated, the discitis may resolve on its own, cause a chronic low grade infection, or progress to osteomyelitis and possibly even an epidural abscess. In case of concomitant inflammation of one or more vertebrae (in such cases usually the areas adjacent to the intervertebral disc spaces)^[1] the condition is called spondylodiscitis.

Causes

There is debate as to the cause, although hematogenous seeding of the offending organism is favored as well as direct spread. It is important to differentiate between spontaneous discitis which is usually from hematologic spread from a urinary or respiratory infection versus that from a post-operative complication which usually involves skin flora such as staph aureus.

The cause may be aseptic.^[2]

Diagnosis

An infected disc at the level of C5 C6 causing neurological symptoms

Diagnosis is usually apparent on MRI although plain X-rays and CT examinations can be suggestive. The MRI will reveal air changes in the disc and possibly even external involvement involving the bone or epidural regions. A biopsy may be performed and helps with diagnosis in some cases but often an organism is not obtained. C-reactive protein levels and ESR levels will be elevated and are useful for treatment. Often, the white blood cell count will be normal and the patient will be afebrile.

Treatment

Treatment usually includes antibiotics, and reducing the mobility of the affected region, either with a back brace or a plaster cast. Without treatment, the patient may form an abscess which may need to be surgically corrected. Due to the poor vascularity of the disc, drugs required for treatment often include potent agents such as Ciprofloxacin along with Vancomycin. Occasionally, oral drugs can be used to treat the infection but it may fail and IV drugs may be required.

If the patient is an adult many surgeons and doctors now recommend moving little and often and within the pain limits of the medication. Discs respond to osmotic pressure therefore movement is beneficial to increase their blood flow and fluid dynamics. This is why disc patients are no longer told to bed rest. In children whether to bed rest or move a little is decided on an individual basis, depending on the site and severity of the discitis.

References

^ Page 147 in:Hinchcliffe, Ronald; Fritz Hefti; Jundt, Gernot; Freuler, F. (2007). Pediatric Orthopedics in Practice. Berlin: Springer. ISBN 3-540-69963-5.
^ Langlois, S.; Cedoz, J. P.; Lohse, A.; Toussirot, E.; Wendling, D. (2005). "Aseptic discitis in patients with ankylosing spondylitis: a retrospective study of 14 cases". Joint, bone, spine : revue du rhumatisme 72 (3): 248–253. doi:10.1016/j.jbspin.2004.05.015. PMID 15850997. edit

External links

Learning Radiology: Damage appears on an X-ray image

Discitis in young children: From The Hospital for Children, London, England

UpToDate Contents

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1. 椎骨骨髄炎および椎間板炎 vertebral osteomyelitis and discitis
2. 小児および思春期における腰痛：原因の概要 back pain in children and adolescents overview of causes
3. 米国における真菌による中枢神経系感染症および骨関節感染症のアウトブレイク：治療 outbreak of fungal central nervous system and osteoarticular infections in the united states treatment
4. 成人における非結核性抗酸菌による骨髄炎の治療 treatment of osteomyelitis due to nontuberculous mycobacteria in adults
5. 小児における跛行の原因に関する概要 overview of the causes of limp in children

English Journal

Low yield of ED magnetic resonance imaging for suspected epidural abscess.

El Sayed M, Witting MD.AbstractPURPOSE: The aim of this study was to estimate the yield of emergency department (ED) magnetic resonance imaging (MRI) in detecting spinal epidural abscess (SEA) and to identify clinical factors predicting positive MRI results.
The American journal of emergency medicine.Am J Emerg Med.2011 Nov;29(9):978-82. Epub 2010 Aug 2.
PURPOSE: The aim of this study was to estimate the yield of emergency department (ED) magnetic resonance imaging (MRI) in detecting spinal epidural abscess (SEA) and to identify clinical factors predicting positive MRI results.BASIC PROCEDURE: We examined a cohort of patients who underwent MRI to ru
PMID 20674237

Magnetic Resonance evaluation of tubercular lesion in spine.

Jain AK, Sreenivasan R, Saini NS, Kumar S, Jain S, Dhammi IK.SourceDepartment of Orthopedics, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India, dranilkjain@gmail.com.
International orthopaedics.Int Orthop.2011 Oct 29. [Epub ahead of print]
PURPOSE: Information on Magnetic Resonance (MR) features of active and healed lesions in tuberculosis (TB) spine are lacking. We evaluated MRI findings in active and healed proven TB spine to establish the diagnostic features.MATERIALS AND METHOD: Forty-nine consecutive spinal TB patients (20 male;
PMID 22038440

Japanese Journal

著しい多発性膿瘍を形成した血液透析患者の1例

金子友香,徳山博文,脇野修,木田可奈子,林松彦,林晃一,伊藤裕
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 44(10), 1047-1052, 2011-10-28
慢性腎不全維持血液透析中，低栄養，鉄過剰症，骨髄異形成症候群（MDS）など複数の免疫能低下に寄与する要因が重なり，メチシリン感受性黄色ブドウ球菌（MSSA）によるシャント感染・敗血症を契機に多発膿瘍の合併に至った症例を経験した．透析患者のシャント感染を契機に，本症例のような重症多発性化膿性膿瘍を合併することはまれであり，文献的考察を加え報告する．症例は67歳，女性．慢性糸球体腎炎を原病として，慢性 …
NAID 10029861821

神経麻痺を伴った硬膜外膿瘍に対する低侵襲後方除圧術

梅田眞志,串田剛俊,池浦淳,若林英,笹井邦彦,飯田寛和
中部日本整形外科災害外科学会雑誌. 中部日本整形外科災害外科学会抄録 53(6), 1293-1294, 2010-11-01
NAID 10027629052

Related Pictures

★リンクテーブル★

リンク元	「椎間板炎」「diskitis」
拡張検索	「spondylodiscitis」

「椎間板炎」

Discitis
	Classification and external resources
	Discitis in a 2 year old child.
ICD-10	M46.4
ICD-9	722.90
DiseasesDB	3847
MedlinePlus	000993
eMedicine	article/1263845
MeSH	D015299

　　[★]

英: discitis, diskitis
同: 化膿性椎間板炎 pyogenic discitis
関: 脊椎椎間板炎

「diskitis」

　　[★]

椎間板炎

関: discitis、spondylodiscitis

「spondylodiscitis」

　　[★] 脊椎椎間板炎

関: discitis、diskitis

[1] Page 147 in:Hinchcliffe, Ronald; Fritz Hefti; Jundt, Gernot; Freuler, F. (2007). Pediatric Orthopedics in Practice. Berlin: Springer. ISBN 3-540-69963-5.

[2] Langlois, S.; Cedoz, J. P.; Lohse, A.; Toussirot, E.; Wendling, D. (2005). "Aseptic discitis in patients with ankylosing spondylitis: a retrospective study of 14 cases". Joint, bone, spine : revue du rhumatisme 72 (3): 248–253. doi:10.1016/j.jbspin.2004.05.015. PMID 15850997. edit

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discitis