Spine Health & Spinal Hygiene

Spondyloarthritis is a group of inflammatory, immune-mediated diseases that cause chronic low back pain, inflammation, irritating aches, and pains. The conditions mostly affect the spine but can affect joints in the arms, legs, hips, skin, eyes, and intestines. Spondylitis types can significantly affect daily function, physical activity and compromise bone health.

Spondylitis Types

The main types include:

• Ankylosing spondylitis
• Psoriatic arthritis
• Enteropathic arthritis
• Reactive arthritis
• Juvenile spondylitis
• Undifferentiated spondylitis

Axial Spondylitis vs. Peripheral Spondylitis Types

Spondylitis conditions are classified as axial - axSpA or peripheral - pSpA.

• Axial means relating to the body's central region, as in the trunk and head.
• Axial spondyloarthritis is arthritis and inflammation in the hips and spine.
• The condition starts before age 45.
• The pain typically starts in the low back but can begin in the neck or other regions.
• Characterized by back pain, usually in the lower back and/or buttocks.
• Morning back stiffness lasting 30 minutes or longer.
• Sacroiliac joint inflammation can also present.
• The back pain gradually progresses.
• Lasts longer than three months.
• Improves with physical movement, not with rest.
• Peripheral spondyloarthritis is arthritis and inflammatory pain in the peripheral joints and tendons and does not include the spine.
• Individuals can have peripheral and axial spondylitis symptoms simultaneously.
• Diagnosis depends on whether symptoms are primarily peripheral or axial.

Spondylitis and Spondylosis

Spondylosis and spondylitis are similar in they cause pain and inflammation in the back and hips. The difference is in each condition's triggers.

• Spondylitis is a disease in which the body's immune system degrades joints, causes inflammation, overproduces bone formation, and causes bone fusion.
• Spondylosis is a category of arthritis that presents as the spine ages from normal wear and tear.
• It happens during the degeneration of the spine's discs and joints.
• It also presents when bone spurs develop on the spine's vertebrae.

Ankylosing Spondylitis

Ankylosing spondylitis is the most common form of arthritis affecting the spine, other joints, and body regions. The condition causes spinal joint inflammation causing extreme discomfort and chronic pain. In some cases, the inflammation progresses to ankylosis, where spine sections fuse and become immobile. Other body areas that can trigger inflammation include:

• The ribs
• Heels
• Shoulders
• Hips
• Small joints of the feet and hands.

Ankylosing spondylitis symptoms vary from person to person. Common early symptoms include:

• There is general discomfort, appetite loss, and mild fever early in the condition.
• Persistent stiffness and pain in the buttocks and low back, gradually progressing over a couple of weeks or months.
• The pain and stiffness can travel into the neck and spine within months or years.
• The pain is usually spread out and dull.
• The stiffness and pain are worse in the morning and night and improve with light exercise or a warm shower.
• The pain typically becomes chronic, lasts for a minimum of 3 months, and can be felt on both sides.
• Tenderness and pain in the hips, thighs, shoulder blades, heels, and ribs may also occur.

Treatment approaches include applications of ice and heat to reduce swelling, increase circulation, and decrease joint pain, posture exercises, stretches, physical therapy, and medication.

Psoriatic Arthritis

Psoriatic arthritis causes swelling, pain, and inflammation in the small joints of the hands and feet; however, the joints of the knees, ankles, and wrists can also be affected. Psoriasis is a rash that causes scaly skin patches.

• Individuals can develop dactylitis when a finger or toe swells between the surrounding joints.
• Spinal stiffness and pain can present.
• Typically the ends of the finger joints are most affected and experience pain and inflammation.
• The condition also includes fingernail and toenail symptoms.
• Medications frequently utilized to treat ankylosing spondylitis can be used.
• Exercise helps preserve the range of motion and maintain strength.
• Isometric exercise work muscles without joint motion reducing the risk of further injury to inflamed joints.
• Occupational and physical therapy can significantly assist in optimizing arthritic joint function.

Enteropathic Spondylitis

Enteropathic Arthritis is chronic inflammatory arthritis linked to inflammatory bowel disease. The most recognized are Crohn's and ulcerative colitis.

• The peripheral limb joints and sometimes the whole spine are the most prevalent body areas afflicted with enteropathic spondylitis.
• The main symptom is intestine inflammation, including bowel and joint pain and/or inflammatory back pain.
• Other symptoms can include weight loss, blood in the stool, abdominal pain, and/or chronic diarrhea.
• Managing enteropathic arthritis typically means managing the underlying bowel disease.

Juvenile Spondyloarthritis

Juvenile spondyloarthritis is a group of childhood rheumatic diseases that cause arthritis before age 16 and can continue through adulthood. Juvenile spondyloarthritis encompasses:

• Enteropathic arthritis
• Enthesitis-related arthritis
• Undifferentiated spondyloarthritis
• Psoriatic arthritis
• Reactive arthritis
• Juvenile ankylosing spondylitis

Juvenile spondyloarthritis causes inflammation and pain in joints in the lower body, like the ankles, hips, knees, and pelvis. Other body areas that could be affected include:

• The bowels
• Eyes
• Skin
• Spine

Lethargy and fatigue can also present. The symptoms can be unpredictable and episodic, appearing and disappearing without a specific cause. The condition cycles between flare-ups and remission. Common treatment approaches include:

• Medication
• Exercise
• Posture training
• Physical therapy, medication
• Ice and heat to decrease joint pain and relax muscles.
• In severe cases, surgery could be recommended.

Reactive Arthritis or Reiter's Syndrome

Reactive arthritis is arthritis that causes pain and inflammation in the mucous membranes, bladder, skin, joints, eyes, and genitals.

• Reactive arthritis is believed to be a reaction to an infection, usually in the gastrointestinal or urinary tract.
• Reactive arthritis does not affect the sacroiliac joints and spine in most cases.
• Reactive arthritis is typically treated with nonsteroidal anti-inflammatory medications, steroids, and rheumatoid arthritis medications.
• A physician could prescribe antibiotics if a bacterial infection brought on reactive arthritis.

Undifferentiated Spondyloarthritis

Undifferentiated spondyloarthritis is where the signs and symptoms of spondylitis don't meet the criteria for a specific rheumatoid disorder. Individuals diagnosed with undifferentiated spondyloarthritis will have one or more of the symptoms that include:

• Fatigue
• Back inflammation
• Back pain
• Buttock pain that alternates or presents on both sides.
• Swollen toes or fingers
• Heel pain
• Arthritis in the small joints.
• Arthritis in the large limb joints.
• Enthesitis or inflammation where the ligament or tendon connects to the bone.
• Eye inflammation
• Individuals can also present symptoms of other spondylitis types, like psoriatic or ankylosing.

Treatment approaches include:

• Exercise
• Physical therapy
• Posture training
• Ice and heat to decrease joint pain and loosen up muscles.

Spondylitis Types Diagnosis of Spondyloarthritis

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Carron, Philippe, et al. "Peripheral spondyloarthritis: a neglected entity-state of the art." RMD open vol. 6,1 (2020): e001136. doi:10.1136/rmdopen-2019-001136

Dougados, Maxime, and Dominique Baeten. "Spondyloarthritis." Lancet (London, England) vol. 377,9783 (2011): 2127-37. doi:10.1016/S0140-6736(11)60071-8

Gill, Tejpal, et al. "The intestinal microbiome in spondyloarthritis." Current opinion in rheumatology vol. 27,4 (2015): 319-25. doi:10.1097/BOR.0000000000000187

Rosenbaum, James T. “The eye in spondyloarthritis✰.” Seminars in arthritis and rheumatism vol. 49,3S (2019): S29-S31. doi:10.1016/j.semarthrit.2019.09.014

Seo, Mi Ryoung et al. "Delayed diagnosis is linked to worse outcomes and unfavorable treatment responses in patients with axial spondyloarthritis." Clinical rheumatology vol. 34,8 (2015): 1397-405. doi:10.1007/s10067-014-2768-y

Sharip, Aigul, and Jeannette Kunz. "Understanding the Pathogenesis of Spondyloarthritis." Biomolecules vol. 10,10 1461. 20 Oct. 2020, doi:10.3390/biom10101461

Losing weight can be one of the hardest things to do. It is also one of the best things anyone can do to get rid of back pain and optimize overall health. Achieving and maintaining a healthy weight impacts the whole body, especially the spine. It is prevalent for individuals who are overweight to experience back pain. This comes from the added weight that the feet, legs, pelvis, and spine have to support. For many, once the weight comes off, the back pain reduces significantly and/or disappears completely. For those embarking on a weight loss journey,  our:

• Chiropractic team
• Physical therapists
• Health coach
• Nutritionist
• Can provide resources to plan, encourage, and assist in reaching health goals.

Overweight, Obesity and Back Pain

Spine pain is one of the top reasons individuals see a doctor. The need to lose weight is based on body mass index/BMI. BMI can be an indicator that an individual's weight might not be in a healthy range. BMI ranges:

• Normal weight - Body Mass Index of less than 25
• Overweight - Body Mass Index of 25 to 30
• Obese - Body Mass Index of 31 to 35
• Extremely obese - Body Mass Index of 36 or higher

If unsure about how to get an accurate BMI measurement, talk to our team about InBody Testing.

Added Weight Places Pressure On the Spine

Added bodyweight places added strain on the low back. Studies have linked obesity with degenerative disc problems. Combined with the physical impact the added weight has on the spine and overall health, it can also affect spine surgery outcomes. Studies have shown that some overweight/obese individuals have an increased risk for surgery-related complications like:

• Infection
• Issues recovering from anesthesia
• Overall recovery struggles

The good news is that individuals do not have to lose a significant amount of weight to see and feel the benefits. Losing 15% of excess weight will improve chronic back pain.

Exercise

Successful weight loss is the ability to maintain the loss. It needs to be something that can be committed to and brought into an individual's lifestyle. Trying to go hard with an extreme diet or intense exercise program is not recommended. This is like not having any long-distance running knowledge along with training but entering a 12345K race. An individual will collapse after a few blocks. And sustained weight loss is just that, a long-distance journey that requires:

• Getting educated about what is going on with the body
• Understanding how foods affect/impact the body
• Understanding the body's unique needs to lose weight
• Developing a personal health goal plan
• Following through

Lifestyle factors contribute to healthy body weight. Being able to embed healthy habits into one's life is the objective. Although it can sound easy to do, it can be a challenging process. With professional help, individuals can:

• Maintain a nutritious and balanced diet
• Have an active lifestyle
• Maintain healthy sleep habits
• Keep stress under control

Discussing a weight loss plan is very important. A professional health coach, nutritionist, and chiropractor will develop the right program that considers an individual's specific health status.

Overall Health

Achieving a healthy weight will reduce to relieve back pain completely and significantly improve quality of life. Weight management is challenging, but once the benefits are seen and felt, it becomes second nature.

Body Composition

Healthy Kidneys 

The kidneys pump more than 400 gallons of recycled blood through the body every day. These organs work nonstop to filter blood and remove waste. If the kidneys become impaired, the body can become overloaded with waste. Unhealthy lifestyle choices can harm/damage the kidneys. Kidney disease progresses slowly over the years. Individuals can lose 90 percent of kidney function before symptoms become serious. Chronic kidney disease is not reversible. However, with lifestyle adjustments, an individual can lower their risk of developing kidney-related diseases.

Proper Hydration

Drink plenty of water to clear sodium, urea, and toxins from the body and prevents kidney stones. Try to drink eight 8-ounce glasses of water each day. Every individual's body water levels are different. A body composition test can determine what is normal for the individual.

Maintain healthy diet 

Poor diet contributes to visceral fat gain. This has been linked to chronic kidney disease. Reduce visceral fat by eating a healthy diet of vegetables, fruit, and lean protein. Cut down on salty, processed foods. Body composition testing can help form an individualized diet plan to reduce visceral fat.

 Supplements, antibiotics, and OTC medications

Overuse of common over-the-counter medications and supplements can cause kidney damage and disease. Consult with a doctor before taking medications and supplements if there is kidney function impairment.

Maintain fitness and physical activity

Cardio and strength training exercises are recommended. High blood sugar levels stress the kidneys. Building adequate muscle mass will help control blood sugar. A body composition test can make sure there are adequate amounts of muscle mass.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Liuke M, Solovieva S, Lamminen A, Luoma K, et al. Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond). 2005;29(8):903-908.

Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: the United States, 2011–2014. Centers for Disease Control and Prevention: National Center for Health Statistics.https://www.cdc.gov/nchs/products/databriefs/db219.htm. Page last updated: October 28, 2015. Accessed July 10, 2017

Samartzis D, Karppinen J, Chan D, Luk KD, et al. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: A population-based study. Arthritis & Rheumatology. 2012;64(5):1488-1496.

If the sensory system becomes impacted by injury or disease, the nerves in that system can't function in the transmitting of sensation to the brain. This can lead to a sensation of numbness, or lack of sensation. In some cases when the sensory system is injured, individuals can experience pain in the affected region. Neuropathic pain does not start quickly or ends quickly. It's a chronic condition that leads to symptoms of persistent pain. For many, the intensity of the symptoms can come and go throughout a day. Neuropathic pain is thought to be associated with peripheral nerve problems, i.e. neuropathy caused by diabetes, spinal stenosis, injury to the brain or spinal cord can also lead to chronic neuropathic pain.

NEUROPATHIC PAIN

Objectives:

• What is it?
• What is the pathophysiology behind it?
• What are the causes
• What are some of the pathways
• How can we fix it?

NEUROPATHIC PAIN

• Pain initiated or caused by a primary lesion or dysfunction in the somatosensory nervous system.
• Neuropathic pain is usually chronic, difficult to treat and often resistant to standard analgesic management.

PATHOGENESIS OF NEUROPATHIC PAIN

• PERIPHERAL MECHANISMS
• After a peripheral nerve lesion, neurons become more sensitive and develop abnormal excitability and elevated sensitivity to stimulation
• This is known as...Peripheral Sensitization!

• CENTRAL MECHANISMS
• As a consequence of ongoing spontaneous activity arising in the periphery, neurons develop an increased background activity, enlarged receptive fields and increased responses to afferent impulses, including normal tactile stimuli
• This is known as...Central Sensitization!

COMMON CAUSES

Lesions or diseases of the somatosensory nervous system can lead to altered and disordered transmission of sensory signals into the spinal cord and the brain; common conditions associated with neuropathic pain include:

• Postherpetic neuralgia
• Trigeminal neuralgia
• Painful radiculopathy
• Diabetic neuropathy
• HIV infection
• Leprosy
• Amputation
• Peripheral nerve injury pain
• Stroke (in the form of central post-stroke pain)

PHANTOM LIMB PAIN & AUGMENTED REALITY 

• Phantom Limb Pain and AR

NEUROGENIC INFLAMMATION

Objectives:

• What is it?
• What is the pathophysiology behind it?
• What are the causes
• How can we fix it?

NEUROGENIC INFLAMMATION

• Neurogenic inflammation is a neurally elicited, local inflammatory response characterized by vasodilation, increased vascular permeability, mast cell degranulation, and the release of neuropeptides including SP and calcitonin gene-related peptide (CGRP)
• It appears to play an important role in the pathogenesis of numerous disease including migraine, psoriasis, asthma, fibromyalgia, eczema, rosacea, dystonia and multiple chemical sensitivity

COMMON CAUSES

• There are multiple pathways by which neurogenic inflammation may be initiated. It is well documented, using both animal models and isolated neurons in vitro, that capsaicin, heat, protons, bradykinin, and tryptase are upstream regulators of the intracellular calcium influx, which results in inflammatory neuropeptide release. In contrast, it is thought that prostaglandins E2 and I2, cytokines, interleukin-1, interleukin-6, and tumor necrosis factor do not cause neurotransmitter release themselves, but rather excite sensory neurons and thus lower the threshold for firing and cause augmented release of neuropeptides.
• While neurogenic inflammation has been extensively studied and well documented in peripheral tissues, until recently the concept of neurogenic inflammation within the CNS has remained largely unexplored. Given the capacity for neurogenic inflammation to influence vascular permeability and lead to the genesis of edema, it has now been widely investigated for its potential to influence BBB permeability and vasogenic edema within the brain and spinal cord under varying pathological conditions.

Anatomy Of The Brain

Syringomyelia is a disorder in which a fluid-filled cyst/syrinx forms within the spinal cord. It is progressive, meaning that the cyst grows with time causing compression and damage to the spinal cord. The cyst usually begins in the neck/cervical spine but can develop in any area along the spinal cord. There are several possible causes; however, most are associated with a condition known as Chiari malformation. This is where the skull and neck come together, and either the skull is too small or shaped in a way that causes brain tissue to come out and settle in the spinal canal.

Syringomyelia Causes

Syringomyelia can be caused by or from complications of:

• Congenital disabilities like Chiari malformation
• Chiari type I malformation develops during the fetal developmental stage and causes the lower part of the brain or cerebellum to stick out from its standard location.
• Hemorrhage/bleeding
• Inflammation of the spinal cord from virus or bacterial infection like meningitis
• Spinal cord injury
• Spinal cord tumor

Symptoms

A damaged spinal cord disrupts communication between the brain and the body. Symptoms differ for every individual, but common syringomyelia symptoms include:

• Pain, stiffness, or weakness in the neck, arms, back, and/or legs
• Progressive numbness
• Headache/s
• Sensitivity to heat and cold
• Muscle atrophy, contractions, spasticity/tightness 
• Skin rash

Symptoms usually develop slowly, but exercise, coughing, or some form of strain can cause sudden onset.

Diagnosis

Physical and neurological exams are performed to determine loss of feeling or inability to move around normally, like walking. Diagnostic tests of the spine will include a CT scan with contrast dye and/or an MRI. Early detection can help before it progresses, causing further damage, and delaying treatment can cause irreversible spinal cord injury. It is recommended at the first sign of symptoms to contact a doctor.

Treatment

Some individuals who have syringomyelia may have no symptoms. These individuals can go about their everyday lives but are recommended to be cautious with neck and back strain. For individuals experiencing symptoms, the primary treatment objectives are to:

• Stop or control damage to the spinal cord
• Preserve function
• Prevent disability
• Treatment options include:
• Draining the cyst
• Surgical removal of the cyst
• Chiropractic and physical therapy could be included in the treatment plan to help the individual rebuild lost muscle strength and regain flexibility.

All too often, individuals with this disorder experience treatment delay/s because symptoms can be nonspecific or vague. Education is the key, and individuals can be diagnosed sooner by paying attention to the body's warning signs.

Body Composition

Does too much protein hurt the kidneys?

While protein restriction can be appropriate for treating existing kidney disease, research shows that high protein intake in healthy individuals does not disrupt or cause damage to the kidneys or kidney function. The amino acids in protein are more likely to be excreted through urine when not being used. However, there are certain risks associated with consuming too much protein, and it is recommended to keep track of protein intake. Eating more protein:

• Makes the body feel full longer
• Can help curb overeating
• Is essential for recovery and growth

When achieving daily caloric goals, maintaining a balance of nutrients like carbohydrates and healthy fats is essential for overall health.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Batzdorf, Ulrich. "Primary spinal syringomyelia. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005." Journal of neurosurgery. Spine vol. 3,6 (2005): 429-35. doi:10.3171/spi.2005.3.6.0429

Di Lorenzo, N, and F Cacciola. "Adult syringomyelia. Classification, pathogenesis and therapeutic approaches." Journal of neurosurgical sciences vol. 49,3 (2005): 65-72.

Fernández, Alfredo Avellaneda et al. "Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis, and treatment)." BMC musculoskeletal disorders vol. 10 Suppl 1, Suppl 1 S1. 17 Dec. 2009, doi:10.1186/1471-2474-10-S1-S1

Naftel, Robert P et al. "Worsening or development of syringomyelia following Chiari I decompression: case report." Journal of neurosurgery. Pediatrics vol. 12,4 (2013): 351-6. doi:10.3171/2013.7.PEDS12522

Roy, Anil K et al. "Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management." Neurosurgical focus vol. 31,6 (2011): E15. doi:10.3171/2011.9.FOCUS11198

Discitis is typically caused by an infection that grows in one of the spine’s vertebral bones and possibly in the intervertebral discs. Discitis is usually a bacterial infection, but it can be viral.

Discitis affects around 1 out of every 100,000 people. This means that it is not a common spinal disease. Discitis can occur in adults and children, however, it is more common in children.

• Discitis mostly occurs in the low back region of the spine
• Followed by the neck region
• Finally the middle-back region

It accompanies vertebral osteomyelitis. Both types of infections share many of the same symptoms/characteristics. Although these are uncommon conditions, they can produce severe symptoms affecting an individual's quality of life. This is why early diagnosis and treatment are essential.

Discitis Causes

There are two recognized causes of discitis. The rarest form comes from a prior surgical or diagnostic procedure. This usually happens when a needle or other tool/device transfers the infection. The other is the more common, and it is known as spontaneous discitis. Here the infection develops from a bacterial or viral organism that travels to the disc/s via the blood supply from another part of the body.

When an infection starts somewhere else and then travels to the disc, it is called transient bacteremia, which is bacteria in the bloodstream that has a short life. Ear infections along with skin infections are perfect examples of infections that can lead to transient bacteremia and discitis.

After a disc becomes infected, it can be quite difficult for the body to fight the infection. The disc/s are the largest avascular organs in the body, which means they do not have their own blood supply. The discs get their nutrition and blood supply, which includes the white blood cells for fighting infections, from the vertebral endplates. 

Because the discs lack the resources to fight infections on their own, there is a struggle when trying to protect against infection.  Because discitis is usually caused by an infection that developed in another area of the body, individuals with medical conditions are at a higher risk for developing discitis. These conditions include:

• Diabetes
• A.I.D.S
• Cancer
• Chronic kidney disease

Symptoms

Intense back pain that starts gradually is the distinctive characteristic symptom of discitis. The pain is usually localized to the area where the infection is located. This means that the pain doesn't radiate or spread out like other types of back pain conditions.

Diagnosis

A doctor, spine specialist, or chiropractor will review medical history and symptoms with the individual. A fever is normally not present once the infection is inside the disc, along with the white blood cell count being normal.

However, the erythrocyte sedimentation rate increases. This is a blood test that examines how fast red blood cells fall to the bottom of a tube. The faster that they fall to the bottom, the more likely there is inflammation somewhere in the body.

Blood tests can be utilized during diagnosis, however, the most accurate diagnostic tool to confirm discitis is magnetic resonance imaging or MRI that shows if an infection is present.

Treatment

Treatment can be challenging. This is because of the fact that the discs do not have a blood supply, and medications/antibiotics travel through the blood. It is treatable and is usually done within a six to eight-week course of antibiotics intravenously or through an IV.

IV administered antibiotics could require treatment on an outpatient basis. The entire course of antibiotics must be completed in its entirety in order to manage the discitis. A doctor could also prescribe a spinal brace to help stabilize the spine and reduce pain. A brace can limit movement, however, it will help ensure proper healing.

Spinal Infections

Spinal infections can present spontaneously or as secondary conditions, e.g. after a surgical procedure. Spinal infections can affect different structures, like the:

• Vertebral column or the bones of the spine
• Intervertebral disc space, which is the cushion-gel structures between the vertebrae
• Spinal canal

Here are some facts about the occurrence and prevalence of different infections of the spine:

• Vertebral osteomyelitis is the most common type of infection. It affects an estimated 27,000 to 66,000 people a year.

• Epidural abscess is an infection inside the spinal canal that affects up to two cases per 10,000 in hospital admissions around the U.S. It is pretty common in individuals with vertebral osteomyelitis or discitis. Eighteen percent of those individuals can develop this infection. However, it is more common in people fifty and older.

• Discitis, as aforementioned is a pretty uncommon condition. Although, treatment has advanced, around twenty percent of individuals with this infection do not survive.

Infection Risk Factors

There are certain factors that increase the risk of developing an infection. These factors include:

• Arthritis
• Diabetes
• Drug addiction
• Immunosuppression, which can come from Acquired Immunodeficiency Syndrome or medical treatment for tumors
• Malnutrition
• Obesity
• Organ transplant
• Recent urinary tract instrumentation
• Smoking

Symptoms and Diagnosis

Symptoms from a spinal infection can vary. However, continuous back pain with no history of trauma or injury. Usually, there is a delay in the diagnosis for an infection of the spine because of the:

• Subtle nature of the symptoms
• Individual's belief that the pain is not serious
• Absence of body-wide symptoms like a fever

Lab results can also complicate the diagnostic process, as they can be misleading. There could be normal white blood cell counts, x-rays that show no abnormalities, and a sensitive diagnostic test like a bone scan might not show that an individual is positive until a week later.

An erythrocyte sedimentation rate is a valuable screening test when it comes to spinal infections. The test can measure inflammation and infection in the body. If a spinal infection is suspected, an MRI could be the most reliable tool to confirm early diagnosis.

Health & Immunity Series

NCBI Resources

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico