Discospondylitis

From Dog
Discospondylitis in a German Shepherd presenting with acute paresis of the hindlimbs
Discospondylitis of the vertebrae of a dog

Discospondylitis is a concurrent intervertebral disk infection and vertebral osteomyelitis of contiguous vertebrae.

This disease is seen most commonly in large and giant breed dogs such as the Great Dane, Burnese Mountain Dog, Rottweiler and German Shepherd[1].

Discospondylitis can affect any area within the vertebral column and is frequently caused by wounds, epidural injections[2], pyothorax, abscesses[3], periodontitis, endocarditis or immune-mediated arthritis[4].

Infectious agents include:

- Bordetella bronchispetica[5]
- Brucella canis - commonly associated with epididymitis, prostatitis and anterior uveitis[6][7]
- Enterococcus faecalis[8]
- Escherichia coli
- Staphylococcus aureus[9], S. intermedius[10]
- Pseudomonas aeruginosa[8]
- Streptococcus spp
- Aspergillus terreus[11][12]
- Scedosporium apiospermum[13]
- Paecilomyces varioti[14]

Clinical signs include fever, anorexia, lameness, back pain, and variable neurological deficits including ataxia, paraparesis and hemiparesis.

Blood results often reveal a leucocytosis and CSF analysis may show a neutrophilic pleocytosis. Detection of serum glial fibrillary acidic protein has significant diagnostic potential as a marker of myelomalacia[15].

Blood cultures are normally positive for bacteria, hemoplasms or fungi. Percutaneous biopsy samples may be required in cases where blood cultures yield negative results[16]. With Brucella spp infections, PCR testing is usually required due to difficulty in culturing the organism[17].

Diagnosis is usually achieved with radiographic, CT or MRI imaging, demonstrating bony end-plate destruction, new bone production and/or collapsed disc space at the site of infection[18] with resultant vertebral subluxation, spinal cord compression[19] and progressive myelomalacia.

A differential diagnosis would include hip dysplasia, vertebral osteochondrosis, epidural empyema[20], intervertebral disc herniation, intervertebral fatty infiltration (small breeds)[21], steroid-responsive meningitis-arteritis[22], polyostotic lymphoma, osteosarcoma and Afghan Hound hereditary myelopathy.

Treatment involves the long-term (2 - 3 months) use of amoxycillin/clavulanate, enrofloxacin or first-generation cephalosporins (cephalexin and cefazolin). Judicious use of nonsteroidal anti-inflammatory drugs is recommended, particularly carprofen or meloxicam. In dogs with severe pain associated with this conditon, short-term use of buprenorphine is also recommended.

In severe painful cases, surgical stabilization may be required using cancellous bone graft[23], screws and polymethylmethacrylate[24]. Relief of spinal compression may also necessitate vertebral hemilaminectomy[25].

A procedure involving fluoroscopy-guided percutaneous discectomy has been reported to treat discospondylitis in dogs[26].

During chronic antibiotic treatment, radiographs of the spine should be repeated monthly for 4 - 6 months[27].

In cases which do not respond to intervention, euthanasia may be necessary due to deteriorating quality of life.

References

  1. Blaine AB, et al (2005) Signalment and clinical features of diskospondylitis in dogs: 513 cases (1980-2001). J Am Vet Med Assoc 227(2): 268-75
  2. MacFarlane PD & Iff I (2011) Discospondylitis in a dog after attempted extradural injection. Vet Anaesth Analg 38(3):272-273
  3. Siems JS et al (1999) Discospondylitis in association with an intra-abdominal abscess in a dog. J Small Anim Pract 40(3):123-126
  4. van der Wel TJ & Meyer HP (1995) Discospondylitis and immune-mediated polyarthritis in a Bernese mountain-dog. Tijdschr Diergeneeskd 120(3):75-77
  5. Cherubini GB et al (2004) MRI findings in a dog with discospondylitis caused by Bordetella species. J Small Anim Pract 45(8):417-420
  6. LeCouteur RA & Grandy JL (2000) Diseases of the Spinal Cord. In Ettinger SJ and Feldman ED (ed): Textbook of Internal Veterinary Medicine, 5th ed. W. B. Saunders Co., Philadelphia, pp:624
  7. Corrente M et al (2010) Detection of Brucella canis in a dog in Italy. New Microbiol 33(4):337-341
  8. 8.0 8.1 Adamo PF & Cherubini GB (2001) Discospondylitis associated with three unreported bacteria in the dog. J Small Anim Pract 42(7):352-355
  9. Schwartz M et al (2009) Two dogs with iatrogenic discospondylitis caused by meticillin-resistant Staphylococcus aureus. J Small Anim Pract 50(4):201-205
  10. Cabassu J & Moissonnier P (2007) Surgical treatment of a vertebral fracture associated with a haematogenous osteomyelitis in a dog. Vet Comp Orthop Traumatol 20(3):227-230
  11. Berry WL & Leisewitz AL (1996) Multifocal Aspergillus terreus discospondylitis in two German shepherd dogs. J S Afr Vet Assoc 67(4):222-228
  12. Garcia ME et al (2001) The value of the determination of anti-Aspergillus IgG in the serodiagnosis of canine aspergillosis: comparison with galactomannan detection. J Vet Med B Infect Dis Vet Public Health 48(10):743-750
  13. Hugnet C et al (2009) Osteomyelitis and discospondylitis due to Scedosporium apiospermum in a dog. J Vet Diagn Invest 21(1):120-123
  14. Booth MJ et al (2001) Temporary remission of disseminated paecilomycosis in a German shepherd dog treated with ketoconazole. J S Afr Vet Assoc 72(2):99-104
  15. Sato Y et al (2013) Serum Glial Fibrillary Acidic Protein as a Diagnostic Biomarker in Dogs with Progressive Myelomalacia. J Vet Med Sci Mar 8
  16. Kinzel S et al (2005) Treatment of 10 dogs with discospondylitis by fluoroscopy-guided percutaneous discectomy. Vet Rec 156(3):78-81
  17. Wanke MM (2004) Canine brucellosis. Anim Reprod Sci 82-83:195-207
  18. Nelson RW, Couto CG (1998) Small Animal Internal Medicine, 2nd ed. Mosby Inc., Missouri, pp:1029
  19. Carrera I et al (2011) Magnetic resonance imaging features of discospondylitis in dogs. Vet Radiol Ultrasound 52(2):125-131
  20. Lavely JA et al (2006) Spinal epidural empyema in seven dogs. Vet Surg 35(2):176-185
  21. Gendron K et al (2012) Magnetic resonance imaging characterization of vertebral endplate changes in the dog. Vet Radiol Ultrasound 53(1):50-56
  22. Tipold A & Stein VM (2010) Inflammatory diseases of the spine in small animals. Vet Clin North Am Small Anim Pract 40(5):871-879
  23. Auger J et al (2000) Surgical treatment of lumbosacral instability caused by discospondylitis in four dogs. Vet Surg 29(1):70-80
  24. Renwick AI et al (2010) Treatment of lumbosacral discospondylitis by surgical stabilization and application of a gentamicin-impregnated collagen sponge. Vet Comp Orthop Traumatol 23(4):266-272
  25. Nanai B et al (2007) Use of intraoperative ultrasonography in canine spinal cord lesions. Vet Radiol Ultrasound 48(3):254-261
  26. Kinzel S, et al (2005) Treatment of 10 dogs with discospondylitis by fluoroscopy-guided percutaneous discectomy. Vet Rec 156(3):78-81, 2005
  27. Shamir MH et al (2001) Radiographic findings during recovery from discospondylitis. Vet Radiol Ultrasound 42(6):496-503