Journal article
Non-infectious thoracic discitis: A diagnostic and management dilemma. A report of two cases with review of the literature
Clinical neurology and neurosurgery, Vol.190, pp.105648-105648
03/2020
DOI: 10.1016/j.clineuro.2019.105648
PMID: 31931336
Abstract
[Display omitted]
•Common non-infectious causes of thoracic spondylodiscitis include degenerative changes, Charcot neuroarthropathy, CPPD or gout.•Full clinical picture including history, presentation, labs, imaging, culture and histopathology need to be assessed for accurate diagnosis.•As noninfectious discitis may in part be a diagnosis of exclusion, careful FU is warranted to verify no emergence of evidence to support infection.
Discitis/ Osteomyelitis is an inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Infection is the most common cause of discitis, which is often spontaneous and hematogenous in origin. However, many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient’s spinal process is due to an infectious versus non-infectious cause can be challenging. Although clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis of bacterial discitis/osteomyelitis due to their high sensitivity; however, their specificity is low. Moreover, both the infectious and non-infectious discitis can appear quite similar on the imaging studies. We present two cases of thoracic discitis with adjacent vertebral osteomyelitis of probable non-infectious etiology. Both were managed with instrumented fusion for stabilization. We also discuss a range of noninfectious causes of discitis/spondylitis and their radiological features which can help differentiate from infectious processes.
Details
- Title: Subtitle
- Non-infectious thoracic discitis: A diagnostic and management dilemma. A report of two cases with review of the literature
- Creators
- Amit Singla - Rutgers, The State University of New JerseyAllison Ryan - Covenant Medical CenterD. Lee Bennett - University of IowaJudy A. Streit - Roy J. and Lucille A. Carver College of MedicineBrianna Mau - Covenant Medical CenterMarek Rozek - Covenant Medical CenterPatrick W. Hitchon - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.190, pp.105648-105648
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.clineuro.2019.105648
- PMID
- 31931336
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Language
- English
- Date published
- 03/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Infectious Diseases; Neurosurgery; Internal Medicine
- Record Identifier
- 9984303907002771
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