Pathophysiology

  • Infection of the intervertebral disc
  • Staphylococcus aureus is the most common causative organism
  • Lumbar region is most commonly affected 

Clinical Features

  • Back pain - localised to the disc level 
  • Fever
  • Weight loss
  • Neurological deficit 
  • Risk factors - diabetes mellitus, HIV, IVDU
  • Examination
    • Point tenderness on palpation of the involved disc
    • Limited ROM 
    • Neurological deficit (rare)

Investigations

  • Elevated inflammatory markers - CRP/ESR
  • Blood cultures
  • MRI - the most sensitive and specific diagnostic test 
  • Biopsy may be performed for histological confirmation / MCS

Management

  • IV ABx - with cover for staph aureus - flucloxacillin, clindamycin 
  • Surgical debridement may be required