Spondylodiscitis Presenting to a Chiropractor

What is it about?

An 80-year-old man under combination therapy for pulmonary tuberculosis presented to a chiropractor with a one-month history of worsening chronic low back pain, yet denied having any respiratory symptoms, weight loss, or night sweats. Two weeks prior, he saw an orthopedist who ordered lumbar radiographs and magnetic resonance imaging (MRI), showing degenerative changes and subtle findings of spondylodiscitis, but was treated conservatively with a nonsteroidal anti-inflammatory drug. The patient was afebrile, yet considering his older age and worsening symptoms, the chiropractor ordered a repeat MRI with contrast, which revealed more advanced findings of spondylodiscitis, psoas abscesses, and epidural phlegmon, and referred the patient to the emergency department. A biopsy and culture confirmed Staphylococcus aureus infection and were negative for Mycobacterium tuberculosis. The patient was admitted and treated with intravenous antibiotics.

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Photo by Gioele Fazzeri on Unsplash

Photo by Gioele Fazzeri on Unsplash

Why is it important?

Spinal infections may affect the vertebrae, discs, spinal canal, and/or paraspinal soft tissues [1], can progress over a span of weeks, and are potentially fatal [2]. They may be classified as pyogenic (i.e., bacterial), granulomatous (e.g., tuberculosis or fungal), or parasitic [3]. The most common cause is the bacteria Staphylococcus aureus, which accounts for 20% to 84% of cases [3]. Spinal infections are rare, affecting between four and 24 individuals per million per year in developed countries [3], yet are more likely to occur among the elderly, immunocompromised, intravenous drug users, and males [3].

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