DiskospondylitisDiskospondylitis(spondylitis and vertebral (spondylitis and vertebral

osteomyleitis)osteomyleitis)

7/27/097/27/09

Trisha J. OuraTrisha J. Oura

Review of DefinitionsReview of Definitions PhysitisPhysitis

– Skeletally immatureSkeletally immature– Possible collapse of vertebral body, spinal abnormalitiesPossible collapse of vertebral body, spinal abnormalities

SpondylitisSpondylitis– Vertebral boneVertebral bone– Direct innoculationDirect innoculation

DiskitisDiskitis– Intervertebral disk onlyIntervertebral disk only

DiskospondylitisDiskospondylitis– Primary infection/inflammation of endplatesPrimary infection/inflammation of endplates– Secondary IVD involvementSecondary IVD involvement

* usually no differentiation between diskitis and diskospondylitis in vet med

PathophysiologyPathophysiology Hematogenous/iatrogenic/trauma/FBHematogenous/iatrogenic/trauma/FB SourceSource

** Urogenital** Urogenital– Respiratory, oral, endocarditis, abscessRespiratory, oral, endocarditis, abscess

Bacterial > FungalBacterial > Fungal– S. aureus, S. intermediusS. aureus, S. intermedius– B. canisB. canis (ZOONOTIC) (ZOONOTIC)– Aspergillus Aspergillus sp.sp.– Spirocerca lupiSpirocerca lupi

Most common sitesMost common sites– Thoracolumbar, lumbosacral Thoracolumbar, lumbosacral – Mobility Mobility focal ischemia? focal ischemia?

Neurologic effectsNeurologic effects

www.bouldervet.com

The ubiquitous plant awn!

Signalment/PresentationSignalment/Presentation SignalmentSignalment

– MalesMales– Giant/large breedGiant/large breed– OlderOlder

Clinical signsClinical signs– Non-specific Non-specific signs of sepsis signs of sepsis– Neurologic deficits, painNeurologic deficits, pain

Recommendations for diagnostics:Recommendations for diagnostics:– MDB: leukocytosis, cystitis/bacteruriaMDB: leukocytosis, cystitis/bacteruria– Cultures: urine, blood, TTW, etcCultures: urine, blood, TTW, etc– BRUCELLA TESTINGBRUCELLA TESTING– Imaging!Imaging!

www.my-pet-medicine.com

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.

ImagingImaging

RadiographicRadiographic– Survey spinal radiographsSurvey spinal radiographs

Nuc-medNuc-med CT/MRCT/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.

RadiographyRadiography

Early/activeEarly/active– Narrowing of IVD spaceNarrowing of IVD space– Loss of endplate marginsLoss of endplate margins– Rarefaction of bone Rarefaction of bone – Bone lysis and/or proliferationBone lysis and/or proliferation– SclerosisSclerosis

Progression/resolutionProgression/resolution– Lack of lytic focusLack of lytic focus– Loss of sclerotic marginsLoss of sclerotic margins– Smoothing of lytic marginsSmoothing of lytic margins– BridgingBridging

**Radiographic findings DO NOT

correlated well with clinical disease**

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

6 yo FS Cocker Sp: lethargy, poorly localized pain

8 yo FS mix: previous acute lymphoplasmacytic hepatitis , now difficult rising, lethargic

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

Now what?Now what? Good prognosisGood prognosis SequelaeSequelae

– Collapse of vertebrae, Collapse of vertebrae, malformation, residual malformation, residual CNS deficitsCNS deficits

TreatmentTreatment– Long course antibioticsLong course antibiotics

(>6 weeks)(>6 weeks)– Based on culture results Based on culture results

(e.g. B-lactam +/- (e.g. B-lactam +/- fluorquinolone/ fluorquinolone/ aminoglycosideaminoglycoside

ReferencesReferences Bahr A. The vertebrae. In: Thrall DE, ed. Bahr A. The vertebrae. In: Thrall DE, ed. Textbook of Textbook of

veterinary diagnostic radiologyveterinary diagnostic radiology. 5. 5thth ed. St. Louis: Sauders ed. St. Louis: Sauders Elsevier, 2007;179-193.Elsevier, 2007;179-193.

Textbook of veterinary internal medicine Website. Textbook of veterinary internal medicine Website. Discospondylitis (spondylitis, vertebral osteomyelitis) . Discospondylitis (spondylitis, vertebral osteomyelitis) . Available at: Available at: http://www.vetmedtext.com/content/default.cfm. Accessed http://www.vetmedtext.com/content/default.cfm. Accessed Jul 26, 2009.Jul 26, 2009.

Burkert BA, SC Kerwin, GL Hosgood, et al. Signalment and Burkert BA, SC Kerwin, GL Hosgood, et al. Signalment and clinical features of diskospondytlitis in dogs: 513 cases clinical features of diskospondytlitis in dogs: 513 cases (1980-2001). J Am Vet Med Assoc 2005;227:268-275.(1980-2001). J Am Vet Med Assoc 2005;227:268-275.

Stern L, R McCarthy, R King, et al. Imaging diagnosis—Stern L, R McCarthy, R King, et al. Imaging diagnosis—discospondylitis and septic arthritis in a dog. Vet Radiol discospondylitis and septic arthritis in a dog. Vet Radiol Ultrasound 2007;48:335-337.Ultrasound 2007;48:335-337.

Shamir MH, N tavor, T Aizenberg. Radiographic findings Shamir MH, N tavor, T Aizenberg. Radiographic findings during recovery from discospondylitis. Vet Radiol during recovery from discospondylitis. Vet Radiol Ultasound 2001;42:496-503.Ultasound 2001;42:496-503.