Infectious and Inflammatory Causes of Back Pain:  Discitis and Ankylosing Spondylitis (AS)

Discitis: Disc Space Infection

Discitis, or disc space infection, is an inflammatory lesion of the intervertebral disc that occurs in adults but more commonly in children. Its cause has been the subject of debate, although most authors believe it to be infectious. The infection probably begins in one of the contiguous end plates, and the disc is infected secondarily. Severe back pain that begins insidiously is characteristic of the disease.

Although most children will continue to walk in spite of the pain, young children may refuse to ambulate. The characteristic finding is extension of the spine and the child's complete refusal to flex the spine. Children with discitis usually are not systemically ill. They rarely have an elevated temperature and their white blood cell count is frequently normal. However the erythrocyte sedimentation rate is usually increased. Lateral radiographs of the spine usually will reveal disc space narrowing with erosion of the vertebral end plates of the contiguous vertebrae. Bone scanning may be helpful in localizing a lesion that is difficult to diagnose clinically. Some bone scans are falsely negative, so the diagnosis of disc space infection should not be excluded simply because the bone scan is normal. Magnetic resonance imaging (MRI) seems to be helpful in identifying a disc space infection.

The appropriate treatment of these lesions has been the subject of controversy. Most authors recommend plaster cast immobilization, a treatment that seems to be effective by itself in many cases. Some authors think that antibiotics also should be given because the condition most likely is an infection of the disc (the organism involved is frequently Staphylococcus aureus). In treating the lesion in children, a biopsy is not usually necessary. A biopsy may be indicated in adolescents or adults, especially if drug abuse is suspected, because of the possibility of organisms other than Staphylococcus aureus being present.

Courtesy of: http://www.spineuniverse.com 

Ankylosing Spondylitis

What is ankylosing spondylitis (AS)?

Ankylosing spondylitis (AS) is a condition that mainly affects the spine. The joints of the neck, back and pelvis become inflamed, causing pain and stiffness. The sacroiliac joints are commonly affected in AS. These joints connect the base of your spine (sacrum) to your pelvis. Other joints, such as the hips and shoulders, can also be involved. AS can also affect other parts of the body, such as the eyes, skin, bowel and lungs. The symptoms of AS usually begin between the ages of 15 and 45 years.

What are the symptoms?

The symptoms of AS vary from person to person. The most common are:

• pain and stiffness in the back, buttocks or neck

• symptoms worse after rest (for example, in the early morning) and relieved with exercise

• pain in tendons (which connect muscles to bones) and ligaments (which connect bones to each other), often felt as pain at the front of the chest, back of the heel or underneath the foot.

What causes it?

It is not known what causes AS. There is a gene called HLA–B27 that is associated with AS. Almost nine out of ten people with AS test positive for this gene. However this is a perfectly normal gene and only one in twenty people who have this gene will develop AS. You are more likely to get AS if you have a history of it in your family.

How is it diagnosed?

Many people in the early stages of AS think they have common back pain and do not seek help. However it is important to have AS diagnosed as early as possible as there are many effective treatments available. Your doctor will diagnose AS from your symptoms, a physical examination and blood tests to measure levels of inflammation. Your doctor may also order x-rays of your spine, but these tests can all be normal in the early stages. If your doctor suspects you have AS you should be referred to a rheumatologist, a doctor who specializes in arthritis.

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