Spondylodiscitis of the cervical spine
Updates to Case Attributes
Spondylodiskitis is osteomyelitis of the vertebral bodies and intervertebral discitis secondary to an infectious process. Etiologies include pyogenic, granulomatous ( tuberculous, brucellar, fungal) and parasitic infections. Hematogenous spread of pathogens is the most common route of seeding the vertebral column, resulting in septic emboli in the vertebral endplates which subsequently spread to the disc and vertebra. This leads to erosions, destruction and compression fractures with resulting spinal instability, deformity and risk of cord compression. The infection can breach the bone and spread into surrounding soft tissues, causing paravertebral or psoas abscesses, and track into the spinalcentral canal, forming an epidural abscess.
Predisposing factors include diabetes mellitus, advanced age, intravenous drug use, immunosuppression, malignancy, renal failure, rheumatological disease, liver cirrhosis and previous spinal surgery.
The predominant pyogenic pathogen is S. Aureus with a distant focus of infection being identified in almost 50% of cases. Hematogenous bacterial spondylodiscitis affects preferentially the lumbar spine, followed by the thoracic andthen cervical spine in decreasing frequency.
Although CT is good at delineating bone abnormalites including early endplate erosions, MR is considered the modality of choice for assessment of spondylodiscitis and its associated complications.
Case co-author: Rehana Jaffer, MD, FRCPC
-<p>Spondylodiskitis is osteomyelitis of the vertebral bodies and intervertebral discitis secondary to an infectious process. Etiologies include pyogenic, granulomatous ( tuberculous, brucellar, fungal) and parasitic infections. Hematogenous spread of pathogens is the most common route of seeding the vertebral column, resulting in septic emboli in the vertebral endplates which subsequently spread to the disc and vertebra. This leads to erosions, destruction and compression fractures with resulting spinal instability, deformity and risk of cord compression. The infection can breach the bone and spread into surrounding soft tissues, causing paravertebral or psoas abscesses, and track into the spinal canal, forming an epidural abscess.</p><p>Predisposing factors include diabetes mellitus, advanced age, intravenous drug use, immunosuppression, malignancy, renal failure, rheumatological disease, liver cirrhosis and previous spinal surgery.</p><p>The predominant pyogenic pathogen is S. Aureus with a distant focus of infection being identified in almost 50% of cases. Hematogenous bacterial spondylodiscitis affects preferentially the lumbar spine, followed by the thoracic and cervical spine in decreasing frequency.</p><p>Although CT is good at delineating bone abnormalites including early endplate erosions, MR is considered the modality of choice for assessment of spondylodiscitis and its associated complications.</p><p><em><strong>Case co-author: Rehana Jaffer, MD, FRCPC</strong></em></p><p> </p>- +<p>Spondylodiskitis is osteomyelitis of the vertebral bodies and intervertebral discitis secondary to an infectious process. Etiologies include pyogenic, granulomatous ( tuberculous, brucellar, fungal) and parasitic infections. Hematogenous spread of pathogens is the most common route of seeding the vertebral column, resulting in septic emboli in the vertebral endplates which subsequently spread to the disc and vertebra. This leads to erosions, destruction and compression fractures with resulting spinal instability, deformity and risk of cord compression. The infection can breach the bone and spread into surrounding soft tissues, causing paravertebral or psoas abscesses, and track into the central canal, forming an epidural abscess.</p><p>Predisposing factors include diabetes mellitus, advanced age, intravenous drug use, immunosuppression, malignancy, renal failure, rheumatological disease, liver cirrhosis and previous spinal surgery.</p><p>The predominant pyogenic pathogen is S. Aureus with a distant focus of infection being identified in almost 50% of cases. Hematogenous bacterial spondylodiscitis affects preferentially the lumbar spine, followed by the thoracic then cervical spine.</p><p>Although CT is good at delineating bone abnormalites including early endplate erosions, MR is considered the modality of choice for assessment of spondylodiscitis and its associated complications.</p><p><em><strong>Case co-author: Rehana Jaffer, MD, FRCPC</strong></em></p><p> </p>