Discitis / Osteomyelitis

FACTS

 

HPI

Ask consulting provider:
- is this new or the first time we pick this up? 
- have they failed medical therapy? What ABx have been tried for how long? 
- what do we believe to be the source? 
- do we need source control in the neuro axis?
Ask patient
  • Do you take any steroids?
  • Any history of trauma?
  • Any urinary tract infections?
  • PMHx: specifically evaluate for:
    • Any diabetes and what is last A1c
    • Cancer
    • immunocompromised status
  • PSHx:
    • any brain or spine surgery with history of infections?
    • any other infectious history (e.g. infected joints)
  • Social:
    • tobacco
    • etoh
    • any IVDU ever

PHYSICAL EXAM

evaluate for peripheral neuropathy, venous stasis in LEs
evaluate dentition
evaluate all incisions
rectal exam if lumbar

IMAGING

MRI: evaluate marrow signal abnormality, vertebral height loss, retropulsion w/ extent of spinal narrowing
CT: evaluate destructive changes, disc space widening
A/P
  • Admit to medicine unless clearly operative
  • Trial medical management
  • Post void residuals
  • spinal precautions only if unstable
Infectious Labs / Cx workup:
  • ESR/CRP
  • HgA1c
  • PAB
  • UA / UCx
  • BCx
Infectious Imaging workup:
  • Pan neuro-axial CT to evaluate other disc osteo
  • MRI w/wo contrast in regions as indicated
  • standing scoli films for baseline alignment
  • TTE +/- TEE as indicated per ID
  • CXR
Consults
  • ID consult for ABx
  • IR c/s for disc space biopsy
  • consider dental c/s of dentition very poor and possible source
 
Figure 1: MRI w/ contrast showing T12/L1 disc osteo
Figure 1: MRI w/ contrast showing T12/L1 disc osteo