Pyogenic infections occurring primarily in intervertebral discs.

Pyogenic osteomyelitis ofthe spine has been fully described by Wilensky (1929), Kulowski (1936), Compere and Garrison (1936), Gun (1946), Wiley and Trueta (1959), Robinson and Lessof (1961), Pritchard and Robinson (1961) and recently by Griffiths and Jones (1971). Pyogenic infection ofthe intervertebral disc in children has been documented by Saenger (1950), Bremner and Neligan (1953), Dupont and Andersen (1956), Mathews, Wiltse and Karbelnig (1957), Doyle (1960), Jamison, Heimlich, Miethke and O’Loughlin (1961), Milone, Bianco and Ivins (1962) and by Menelaus (1964). However, the latter condition has not been so clearly recognised in the adult, for, as Ghormley, Bickel and Dickson (1940) suggested, many authors do not differentiate between osteomyelitis and intervertebral disc infections. Ghormley and colleagues described what they considered to be an acute infectious lesion of the intervertebral disc in twenty patients ranging in age from nine to fifty-nine, basing their evidence on clinical and radiological observations. Although it is generally accepted that the lesion is caused by pyogenic infection in childhood, Alexander (1970) suggested that infection was only an occasional cause and that most cases complicated partial dislocation of the epiphysis of the vertebral body during growth. It has been difficult to obtain evidence of the etiology of the condition in children, though Milone et a!. (1962) obtained material either by needling or by open biopsy from five of their young patients and cultured Staphylococcus aureus on each occasion. Doyle (1960) and Menelaus (1964) showed that in children the infection remained within the disc, the duration ofthe disease was relatively short and the prognosis was excellent, provided treatment was adequate. For the past twelve years it has been the practice at the Royal National Orthopaedic Hospital to explore nearly all inflammatory lesions of the spine in order to confirm or establish the diagnosis, to isolate and determine the antibiotic sensitivities ofthe organism, and to perform radicalclearanceofdiseasedtissues. Graftshave beeninsertedwhenever the stability of the affected area was in question. This radical approach, based on the work of Hodgson and Stock (1956, 1960) was adopted in order to assess its value in the management of spinal infections and is the subject of a separate review (Kemp, Jackson, Jeremiah and Cook 1973). The purpose of this paper is to define infections of the intervertebral disc in the late adolescent and in the adult, to compare and contrast the presentation with the condition observed in children, and to consider the management and prognosis.