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Background: Pyogenic spondylodiscitis is a rare disease that is being diagnosed with increasing frequency in recent years. It is associated with a high morbidity and mortality., Diagnosis: Often, because of its nonspecific symptoms, pyogenic spondylodiscitis is diagnose with some delay. In addition to pathogen detection, MRI is the gold standard to diagnose pyogenic spondylodiscitis. Also, x-ray imaging and CT can be carried out for surgical planning and for subsequent follow-up imaging. If blood or tissue cultures are negative, open surgical biopsies should be preferred over CT-guided biopsies., Therapy: The therapy can be conservative, such as immobilization, as well as antibiotics and analgesics, or surgical. If, for example, neurological deficits, spinale instabilities or deformities, septic disease progression or extensive abscess formations are present, surgical therapy is indicated. The surgical treatment strategies depend on the severity of the disease., Outlook: The prognosis is dependent on a rapid diagnosis and a swift start to therapy. There is no clear evidence with regard to treatment options (conservative vs. surgical therapy).

The choice of implant in an infection of the spine depends on what type of infection it is: discitis, spondylodiscitis, early infection after spinal surgery, or a late infection. The appropriate treatment strategies vary. In spondylodiscitis, a titanium implant may be necessary. In implant-associated early infections, surgical sanitization is often sufficient without changing the implant. In late infections, implant exchange is necessary because of biofilm.

The incidence of spondylodiscitis is increasing and attributable to an aging population with multimorbidities. Spondylodiscitis represents a life-threatening disease. Typical clinical manifestations often involve nonspecific symptoms with back pain; however, due to the frequent absence of fever the disease is often overlooked. Pathogen detection and spinal imaging with magnetic resonance imaging (MRI) are essential for the diagnosis. Identification of the causative pathogen is particularly important for initiating targeted antibiotic treatment. Debridement and stabilization are the mainstays of surgical management, even though foreign material must be implanted into the focus of inflammation.

Septic arthritis and spondylodiscitis are relatively rare but severe diseases with increasing incidence. Septic arthritis is an emergency situation with high morbidity (40 %) and fatality rates (11 %). The infection occurs via a hematogenous route by direct inoculation or per continuitatem. Patients with pre-existing destructive joint diseases or under immunosuppressive treatment are particularly at risk. It is mandatory to sample synovial fluid for isolation of the relevant pathogen and quantification of leucocytes before starting antibiotic therapy. In order to preserve the joint, early evacuation of the infected synovial space is necessary. Spondylodiscitis is characterized by infection of the vertebra and neighboring discs mainly via a hematogenous route. Immunosuppressed and older patients are primarily at risk of infection. Back pain represents the main symptom but due to its unspecific character and the frequent absence of fever, diagnosis is often delayed. In Europe Staphylococcus aureus is the most prevalent pathogen, whereas tuberculosis is the most frequent causal agent worldwide. Magnetic resonance imaging (MRI) respresents the method of choice for the radiological diagnostics. In stable patients isolation of the pathogen should be achieved before starting antimicrobial therapy (e.g. blood cultures or tissue samples by computed tomography guided puncture or biopsy). The recommended duration of pathogen-specific antibiotic therapy for native spondylodiscitis is normally 6 weeks.

Background: Spondylodiscitis in children is rare. The condition has an incidence of 2 to 4 % of all infectious skeletal diseases in children., Aim: Aim of the article is the presentation of epidemiology, the clinical signs, radiological findings as well the treatment options of non-specific and specific spondylodiscitis in children., Methods: The available literature was reviewed., Results: Non-specific spondylodiscitis in children is caused by haematogenous spread of pathogens. Staphylococcus aureus is the most frequently detected bacterium. The clinical signs are unspecific and an Magnetic Resonance Imaging of the spine is the standard radiological procedure to detect spondylodiscitis. In general, the treatment is conservative and includes an antibiotic therapy as well an immobilization of the spine. In endemic areas of the world, specific spondylodiscitis is more common and is caused by Mycobacterium tuberculosis or Brucellae. The treatment is also conservative. For all entities of spondylodiscitis in children, a surgical intervention is only necessary in the case of severe deformities due to the infection or in the case of neurological symptoms., Conclusion: Elevated infectious laboratory values and back pain or other unspecific symptoms can indicate spondylodiscitis in children. MRI of the spine is necessary to rule out spondylodiscitis.

Background: The clinical presentation of spondylsodiscitis/spondylitis are manifold. This commonly leads to a period of several months from initial symptoms to final diagnosis. A standardised treatment is difficult. The purpose of this study is to investigate the treatment carried out for patients with spondylodiscitis or spondylitis to develop an individualised standard care for better treatment., Patients and Methods: Data of 90 patients were retrospective analysed. In particular documented data of the initial examination and the following treatments concerning identification of causes and systematically control of pathogens were examined., Results: In 91 % of patients a diagnostically conclusive MRI was conducted. The degree of spondylidiscitis/spondylitis was mainly ASA criteria I or II (86 %). In 96 % of patients different diagnostic methods for identification of pathogens were conducted and documented. RESULTS confirmed the most common pathogens mentioned in the literature. 75 % of patients were treated by surgery. In 93 % of patients an antibiotic treatment was documented. 50 patients (81 %) were successfully healed., Conclusion: It is important to identify and treat spondylodiscitis/spondylitis as early as possible. Diagnosis by means of blood culture and MRI and treatment of the infection with antibiotics and possibly surgical interventions seem be very suitable, but need to be individualised to each and every patient., (Georg Thieme Verlag KG Stuttgart · New York.)

In most cases spondylodiscitis is due to a monomicrobial infection caused by hematogenous dissemination of Staphylococcus aureus. There are, however, many other possible pathogens causing spondylodiscitis and the pathogen responsible can only be identified in approximately 50% of cases. This leads to delayed diagnosis and therapy and an increased morbidity and mortality rate. Failures in planning and performing material recovery are often the reason. As pathogen-specific antimicrobial treatment according to the results of susceptibility testing is the main component of interdisciplinary therapy, all available methods for identification of the pathogen, such as blood cultures, intraoperative and computed tomography (CT) guided biopsies of inflammatory fluids and tissues as well as molecular biological methods should be performed to optimize antimicrobial therapy.

History and Clinical Findings: Three patients with different forms of vertebral osteomyelitis are presented, two with hematogenous infections caused by Streptococcus pneumoniae and Staphylococcus aureus and one with postsurgical infection after excision of a vertebral disc caused by coagulase-negative staphylococci. None of the patients was initially febrile, but all had localized back pain and a restricted range of movement of the vertebral column. EXAMINATIONS, DIAGNOSIS: In all three patients the MRI of the affected vertebral column was consistent with vertebral osteomyelitis. Microbiological diagnosis was made by bone biopsy in all patients and by blood cultures in two of them., Treatment and Course: Antibiotics were administered for 4-6 weeks. At follow-up two patients were without symptoms, but the third patient had persistent back pain without radiological signs of vertebral osteomyelitis., Conclusion: In patients with localized back pain vertebral osteomyelitis should be included in the differential diagnosis, even if there is no fever and no increase in white cell count, the erythrocyte sedimentation rate or C-reactive protein level and radiography is normal. Specific bacterial diagnosis should be made by multiple bone biopsy or blood cultures, before starting appropriate antibiotics.

Spondylodiscitis is a frequently unrecognized disease in childhood because of unspecific symptoms and late arising or radiological signs. The heterogeneous symptoms, the value of diagnostic procedures and the outcome of 8 patients suffering from spondylodiscitis in the time period of 1989 to 1995 are demonstrated. Guiding symptoms were back pain and refusal to walk or sit. Furthermore, abdominal pain and psoas abscess were the only symptoms in two cases. The pathogenomonical narrowing of the disc space arose in X-ray films earliest 3 weeks after onset of symptoms. The MRI was the best method for early diagnosis and detection of complications. In contrast to persistent radiological changes the clinical outcome was good in most of the patients.

The 71-year-old female patient was hospitalized owing to a therapy-resistant lumbo-spondylogenic syndrome. Radiology with increased infection parameters gave rise to the suspicion of a bacterial spondylodiscitis L1/L2. Puncture of the vertebral body as well as blood cultures established proof of yersinia enterocolitica. In spite of immediate adequate antibiosis, by means of "Ciprofloxacin" i.v. spondylodesis of the lumbar spine had to be carried out in order meet the threat of instability. Spondylodiscitis is an extremely rare manifestation of a yersinia infection, only few cases have been described so far in medical literature.

A 19-year-old boy developed paravertebral muscular pain in the lumbar region after an episode of extremely arduous sporting activity, with fever followed by meningism. The cerebrospinal fluid showed a reactive pleocytosis. Initially, no acute inflammatory changes were present on serum and blood analysis, although the erythrocyte sedimentation rate was moderately increased to 25/60 mm. Pyrexia of up to 38.5 degrees C developed 6 days after admission. Because Borrelia IgM and IgG titres were positive, the diagnosis was at first thought to be atypical borreliosis and the patient was treated with antibiotics. However, after a further episode of fever. Salmonella antibody titres, which had initially been normal, rose to 1: 3200 (Salmonella typhi O and H antigens) and 1: 12800 (Salmonella enteritidis, H antigen). At this stage, the erythrocyte sedimentation rate rose to 86/120 mm and the C-reactive protein to 77 mg/dl. The white cell count remained normal throughout. Blood cultures grew Salmonella enteritidis. Abnormalities on bone scintigraphy were confirmed by CT and MRI scans, showing spondylodiscitis of lumbar vertebrae 1 and 2 with limited osteolysis. The lesion resolved completely on 6 week's treatment with ciprofloxacin (200 mg twice a day intravenously) and conservative supportive treatment. Spondylodiscitis is an uncommon complication of salmonellosis and may occur long after the diarrhoea. Cross reactions with Borrelia flagellin antigens may lead to the wrong diagnosis being made.

Four weeks after an attack of bronchopneumonia a 59-year-old veterinary surgeon developed backache. The chest radiograph showed an impression fracture of the 11th thoracic vertebra. Persisting fever led to hospitalization. Several blood cultures grew Salmonella enteritidis. Computed tomography demonstrated a fracture of the 11th thoracic vertebra with osteolytic infiltration and paravertebral soft-tissue infiltration. Bone scan showed band-like contrast enhancement in the same area. Treatment at first consisted of Ciprofloxacin, 200 mg twice daily intravenously for 5 days, then 750 mg orally twice daily for 3 months. The fever regressed within a few days. Sclerosis of the affected vertebral area became radiologically evident after 6 weeks. After this the patient was allowed to move around again, without any further problems.