Discitis—what are we doing?

Abstract

Aims To examine the effect of a wide variation in approach to the management of discitis. Introduction Discitis is considered to be a rare bacterial infection involving the disc space and vertebral end plates. The mainstay of treatment is antibiotic therapy. 11 Consultants with experience of discitis completed a questionnaire. There was wide variation in preferred investigations, duration of antibiotics (2 to 12 weeks) and route of delivery. Of particular note is that four would not have done an ESR and six would not have done a plain X-ray. The authors reviewed recent cases within our Trust to see if these differences were reflected in outcomes. Methods Cases between 2002 and 2008 were reviewed and data regarding presentation, investigations, treatment and outcome analysed. Results Nine patients (5 girls, 4 boys) aged 1 to 8 years (mean 3.1) were identified. All had lumbar (9) or thoracic (2) discitis. Symptoms ranged in duration from 1 day to 6 weeks. The most prevalent symptoms were back pain (6), abnormal spinal curvature (5), off legs (3), and fever (3). Erythrocyte sedimentation rate (ESR) was more strikingly abnormal than C-reactive protein (figure 1). All blood cultures were negative. Biopsy/aspirate in 4 children yielded no growth or alternative diagnosis. Seven of eight spinal x-rays were diagnostic. Eight MRI scans and one CT scan were diagnostic but the need for anaesthetic engendered delay. Duration of treatment ranged from six to thirteen weeks. Intravenous antibiotics ranged from two days to six weeks and included flucloxacillin+cefuroxime (4), co-amoxiclav+flucloxacillin (1), penicillin+flucloxacillin (1), clindamycin+teicoplanin (1), flucloxacillin (1), cefuroxime (1). Oral antibiotics included co-amoxiclav (8), clindamycin+rifampicin (1). All patients were fully mobile and pain free before 6 weeks and there was no clinical or radiological loss of height at 6–12 months. Conclusions There are no adverse outcomes using shorter antibiotic courses or brief intravenous therapy in discitis. Spinal x-rays and ESR can provide sufficient early evidence of discitis to prevent delays in treatment. Biopsies do not influence diagnosis or management.