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  • Discitis is an infection of the disc space and vertebral endplate that is caused by hematogenous or postoperative inoculation.
  • It affects intervertebral discs of the spine.
  • The lower lumbar discs are most commonly involved.
  • However, the infection may occur in any disc.
  • Classification:
  • Spontaneous (hematogenous)
  • Iatrogenic (after discectomy or discogram)
  • Epidemiology
  • Hematogenous infection is uncommon.

The mean age of occurrence of hematogenous (spontaneous) discitis is 7 years, but it may affect individuals of any age.


The incidence of infection after discectomy is <1%.

Risk Factors

  • Compromised host (patients with diabetes, alcohol abuse, transplants)
  • Intravenous drug abuse
  • Procedures involving the disc (discography, discectomy, spinal anesthesia)
  • Bacterial infection:
  • The causative organism most commonly is Staphylococcus, except in the compromised host or intravenous drug abuser, in whom Gram-negative aerobic bacteria and Candida are more common (for these patients, biopsy is indicated).
  • Vascularity issues in children <8 years old:
  • The blood supply to the disc comes from the adjacent vertebral body.
  • Vessels cross the cartilaginous endplate in children until they are approximately 8 years old, and the resultant vascularity renders younger children susceptible to infection in the area.

Associated Conditions

Vertebral osteomyelitis


Signs and Symptoms


  • Back pain, usually insidious in onset but increasing with time
  • Abdominal pain
  • Loss of appetite
  • Malaise
  • Signs:
  • Back stiffness
  • Refusal to walk
  • Pain on spinal percussion
  • Loss of lordosis
  • Fever: Usually low-grade, but may be absent
Physical Exam
  • Note the presence or absence of normal lumbar lordosis.
  • Look for pain or refusal to bend forward.
  • Look for pain on paraspinal percussion.
  • Look for pain on abdominal palpation in lumbar discitis.
  • Neurologic examination remains normal, except in late presentations of fulminant discitis.
  • Tests
  • Lab
  • White blood cell count, ESR, and C-reactive protein usually are mildly elevated but may be normal.
  • Obtain a blood culture even though it is positive <30% of the time.
  • No specific laboratory tests exists for this disorder.
  • Imaging
  • Plain films are positive only after several weeks; they show irregularity and narrowing of the disc space, with mild osseous involvement.
  • MRI:
  • For suspected cases of discitis, shows the pathologic features before abnormalities are visible radiographically.
  • Gives more detailed anatomic information than a bone scan, but a bone scan is an acceptable alternative
  • Pathological Findings
  • Chronic inflammation
  • Destruction of disc structure and endplates
  • Differential Diagnosis
  • Tuberculosis (usually shows more destruction of adjacent bone)
  • Vertebral osteomyelitis (more destruction of bone than disc, but these 2 entities may merge)
  • Treatment
  • General Measures
  • Rest
  • Immobilization
  • Antibiotics
  • For childhood spontaneous discitis, no biopsy or debridement is needed because treatment of staphylococcal infection is virtually always successful.
  • This treatment should be given intravenously if the patient is severely ill, orally if the patient is only mildly symptomatic.
  • Bed rest and bracing may be used if pain is pronounced.
  • For discitis in the compromised host, biopsy and drainage should be performed.
  • Special Therapy
  • Physical Therapy
  • Therapy is useful for adults with severe back stiffness after treatment has begun.
  • Medication (Drugs)
  • For routine spontaneous discitis, oxacillin, dicloxacillin, and cephalosporin are indicated.
  • For complicated cases or in compromised hosts, broad-spectrum antibiotics effective against Gram-negative and anaerobic organisms should be added.
  • NSAIDs or mild narcotics may help patients with severe pain initially until the infection is controlled.
  • Surgery
  • Biopsy may be required in the immunocompromised patient, or one for whom medical therapy has failed.
  • Anterolateral or posterolateral approach with fluoroscopic guidance
  • Drainage may be required for patients who fail to respond to medical management alone.
  • Usually obtained via an anterior approach to allow adequate visualization, debridement, and safety
  • Surgical reconstruction of the spine segment may be indicated for adults with substantial disc space destruction or endplate compromise.
  • Follow-up
  • Prognosis
  • Prognosis is good once the infection has cleared.
  • After childhood discitis, the vertebrae adjacent to the infected disc usually develop a spontaneous painless fusion.
  • In adults, spontaneous fusion does not always occur, and back pain may persist.
  • Complications
  • Persistence of infection (lack of symptom improvement in 1-2 weeks) requires accurate identification of the organism and adequate debridement.
  • Patient Monitoring
  • Physical examination is the most useful means for monitoring infection healing.
  • The examiner should check for tenderness to percussion and range of forward flexion.
  • Radiographs and ESR lag far behind the clinical course.

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