Current Diagnosis and Treatment of Spondylodiscitis: Differential Diagnosis

Abstract

It would have been necessary to describe and specify the differential diagnosis, particularly as it proved to be impossible to avoid the clinically confusing ambiguity of this diagnosis in the title. The underlying problem was the assumption that the terms and also generally and exclusively imply bacterial or purulent pathogenesis and morphology, so that no other terms are needed for postinfectious (secondary) chronicity. This ignores the fact that non-bacterial (aseptic and sterile) osteomyelitis, spondylitis, and spondylodiscitis exist—as rheumatologists have known for many years. In particular, has been recognized, at least since its detailed description in 1973 (1), as a noninfectious and nonbacterial symptom of Bechterew’s disease and of spondyloarthritis (also known as spondyloarthropathy). This frequent and destructive complication is observed in affected motor segments of the spinal column and involves perivertebral tendinopathy. We identified abacterial as primary osteomyelitis in chronic recurrent multifocal osteomyelitis (CRMO) as an entity in patients of all ages. It was differentiated as part of the symptom spectrum of the „SAPHO syndrome“ (www.sapho-syndrom-crmo.de and Orphanet 2004, n ≥173). It has then been subjected to interdisciplinary analysis and the aseptic clinical course of the osteitis has been described as a plasma cell sclerotic process in three steps (2). About a third of all CRMO patients in all age groups develop clinically relevant involvement of the vertebral bodies. These cases of sterile spondylitis can then progress to spondylodiscitis. Thus CRMO is an important differential diagnosis for ankylosing spondylarthritis and one which has largely been ignored (3).