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Spinal Infections

Discitis. This is back pain that presents usually with normal x-rays, the pain can be present for months and can be a very low grade infection. It’s usually staph. The sed rate will usually be elevated, the bone scan is uniformly going to be hot if you have this. The first thing to do is get a sed rate, if it’s normal, then it kind of makes it hard for it to be discitis. Here is an example, this is a little narrowed compared to the other one not noticed at the time but in retrospect it was a little narrowed compared to the one below it. It gets further narrowed as it eats up more of the disc, eventually it fuses together with the one below it.

Once it fuses, then this is mechanically stable, patient can go back to playing football and doing all that sort of stuff. The treatment is antibiotics. Usually, it’s a staph organism, we sometimes do needle biopsies of these, CT guided needle, we have had one kid that had pseudomonas, was diagnosed on that, did well and didn’t have to have surgery. This is an osteoid osteoma which is a very small tumor that is extremely painful, more common at night time, night pain is very common, aspirin or Motrin will usually turn off the pain like a light switch. It has dramatic improvement with salicylates, more common the pain is at night. It’s a small tumor, smaller than a pea, usually presents as a lytic area with a little bit of a center sclerotic area, 20 years ago we would take these all out, it turn out they will burn themselves out after about two years, and you can just treat the patient with salicylates and they will get better as this thing burns out. There are a few exceptions to that, one is in the back, it won’t necessarily go away in the back, and if it’s intra-articular, then it doesn’t seem to respond as well to the salicylates. It’s not malignant tumor, but it’s very painful. I have seen about five of these in 10 years.

Again, this is the differential diagnosis that you want to go through, infections which would be the discitis, tumors, mainly the osteoid osteoma. We have seen someone present with back pain that had a small cell tumor or a lymphoma or something like that, but they usually are pretty sick and it gets sort of obvious. The spondylolysis and spondylolisthesis are very common.

intracanal pathology, intracanal tumors, things like that, you want to think of, and then urinary tract problems also present as back pain, pyelonephritis and things like that.