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Diskospondylitis ( spondylitis and vertebral osteomyleitis )

Diskospondylitis ( spondylitis and vertebral osteomyleitis ). 7/27/09 Trisha J. Oura. Review of Definitions. Physitis Skeletally immature Possible collapse of vertebral body, spinal abnormalities Spondylitis Vertebral bone Direct innoculation Diskitis Intervertebral disk only

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Diskospondylitis ( spondylitis and vertebral osteomyleitis )

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  1. Diskospondylitis(spondylitis and vertebral osteomyleitis) 7/27/09 Trisha J. Oura

  2. Review of Definitions • Physitis • Skeletally immature • Possible collapse of vertebral body, spinal abnormalities • Spondylitis • Vertebral bone • Direct innoculation • Diskitis • Intervertebral disk only • Diskospondylitis • Primary infection/inflammation of endplates • Secondary IVD involvement * usually no differentiation between diskitis and diskospondylitis in vet med

  3. Pathophysiology • Hematogenous/iatrogenic/trauma/FB • Source ** Urogenital • Respiratory, oral, endocarditis, abscess • Bacterial > Fungal • S. aureus, S. intermedius • B. canis (ZOONOTIC) • Aspergillus sp. • Spirocerca lupi • Most common sites • Thoracolumbar, lumbosacral • Mobility  focal ischemia? • Neurologic effects The ubiquitous plant awn! www.bouldervet.com

  4. Signalment/Presentation • Signalment • Males • Giant/large breed • Older • Clinical signs • Non-specific  signs of sepsis • Neurologic deficits, pain • Recommendations for diagnostics: • MDB: leukocytosis, cystitis/bacteruria • Cultures: urine, blood, TTW, etc • BRUCELLA TESTING • Imaging! Burkert BA, SC Kerwin, GL Hosgood, et al. Signalment and clinical features of diskospondytlitis in dogs: 513 cases (1980-2001). J Am Vet Med Assoc 2005;227:268-275. www.my-pet-medicine.com

  5. Imaging • Radiographic • Survey spinal radiographs • Nuc-med • CT/MR Stern L, R McCarthy, R King, et al. Imaging diagnosis—discospondylitis and septic arthritis in a dog. Vet Radiol Ultrasound 2007;48:335-337. Shamir MH, N tavor, T Aizenberg. Radiographic findings during recovery from discospondylitis. Vet Radiol Ultasound 2001;42:496-503.

  6. Radiography • Early/active • Narrowing of IVD space • Loss of endplate margins • Rarefaction of bone • Bone lysis and/or proliferation • Sclerosis • Progression/resolution • Lack of lytic focus • Loss of sclerotic margins • Smoothing of lytic margins • Bridging **Radiographic findings DO NOT correlated well with clinical disease**

  7. 12 yo M bull terrier: Hx chronic back pain, ataxia of few days duration

  8. 6 yo FS Cocker Sp: lethargy, poorly localized pain 8 yo FS mix: previous acute lymphoplasmacytic hepatitis , now difficult rising, lethargic

  9. 5 m MN PitX: hind limb lame x 3 weeks after HBC & IM fixation of L femur fracture 3 mos prior At presentation 3 months later

  10. Now what? • Good prognosis • Sequelae • Collapse of vertebrae, malformation, residual CNS deficits • Treatment • Long course antibiotics (>6 weeks) • Based on culture results (e.g. B-lactam +/- fluorquinolone/ aminoglycoside

  11. References • Bahr A. The vertebrae. In: Thrall DE, ed. Textbook of veterinary diagnostic radiology. 5th ed. St. Louis: Sauders Elsevier, 2007;179-193. • Textbook of veterinary internal medicine Website. Discospondylitis (spondylitis, vertebral osteomyelitis) . Available at: http://www.vetmedtext.com/content/default.cfm. Accessed Jul 26, 2009. • Burkert BA, SC Kerwin, GL Hosgood, et al. Signalment and clinical features of diskospondytlitis in dogs: 513 cases (1980-2001). J Am Vet Med Assoc 2005;227:268-275. • Stern L, R McCarthy, R King, et al. Imaging diagnosis—discospondylitis and septic arthritis in a dog. Vet Radiol Ultrasound 2007;48:335-337. • Shamir MH, N tavor, T Aizenberg. Radiographic findings during recovery from discospondylitis. Vet RadiolUltasound 2001;42:496-503.

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