Non-infectious thoracic discitis: A diagnostic and management dilemma. A report of two cases with review of the literature

• Published in: Clinical neurology and neurosurgery Vol. 190; p. 105648
• Main Authors: Singla, Amit, Ryan, Allison, Bennett, D. Lee, Streit, Judy A., Mau, Brianna, Rozek, Marek, Hitchon, Patrick W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2020; Elsevier Limited
• Subjects: Abscesses; Amyloidosis; Ankylosing spondylitis; Back pain; Bacterial infections; Biopsy; C-reactive protein; Calcification; Calcium; Discitis; Epidural; Erythrocyte sedimentation rate; Esophagus; Etiology; Gout; Granulomas; Hemodialysis; Histology; Infections; Infectious discitis; Inflammation; Intervertebral discs; Literature reviews; Medical imaging; Neurology; Non-infectious discitis; Osteomyelitis; Spondyloarthropathy; Surgery; Thoracic; Thorax; Vertebrae; Vertebral osteomyelitis; Vital signs; Non-infectious discitis; Infectious discitis; Thoracic
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2019.105648

[Display omitted] •Common non-infectious causes of thoracic spondylodiscitis include degenerative changes, Charcot neuroarthropathy, CPPD or gout.•Full clinical picture including history, presentation, labs, imaging, culture and histopathology need to be assessed for accurate diagnosis.•As noninfectious discitis may in part be a diagnosis of exclusion, careful FU is warranted to verify no emergence of evidence to support infection. Discitis/ Osteomyelitis is an inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Infection is the most common cause of discitis, which is often spontaneous and hematogenous in origin. However, many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient’s spinal process is due to an infectious versus non-infectious cause can be challenging. Although clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis of bacterial discitis/osteomyelitis due to their high sensitivity; however, their specificity is low. Moreover, both the infectious and non-infectious discitis can appear quite similar on the imaging studies. We present two cases of thoracic discitis with adjacent vertebral osteomyelitis of probable non-infectious etiology. Both were managed with instrumented fusion for stabilization. We also discuss a range of noninfectious causes of discitis/spondylitis and their radiological features which can help differentiate from infectious processes.