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PEER-REVIEWED

Canine diskospondylitis:
Its etiology, diagnosis, and treatment
Various pathogenic processes can cause bacteria or fungi to infiltrate and multiply
in intervertebral disks. Find out how to diagnose this potentially painful
and crippling problem and what therapy can eradicate the infection.

CAROLINE BETBEZE, DVM DISKOSPONDYLITIS is an infection of The infection may originate from
RON McLAUGHLIN, DVM, DVSc, the intervertebral disk with concur- many sources, with the urinary tract
DACVS rent osteomyelitis of contiguous ver- being most common.2 Most dogs in
Department of Clinical Sciences
College of Veterinary Medicine tebrae.1,2 It occasionally affects dogs, which staphylococci are cultured in
Mississippi State University causing clinical signs that vary from urine also have bacteremia, suggest-
Mississippi State, MS 39762 depression and weight loss to paraly- ing that the urinary tract infection
sis. Early diagnosis and appropriate could be a result of the bacteremia.
therapy are essential to a successful A role for primary urinary tract infec-
outcome.3,4 This article reviews the tions as a cause of diskospondylitis
pathogenesis, diagnosis, and treat- is more evident in cases of gram-
ment of diskospondylitis. negative sepsis. If E. coli is isolated
in blood culture and involvement of
Etiology and pathogenesis the urinary tract is identified, the
Hematogenous spread of bacteria or bacteremia can be attributed to a
fungi is the most common cause of gram-negative genitourinary infec-
diskospondylitis. Staphylococcus inter- tion, since E. coli is the most com-
medius is the bacterial species that monly isolated organism from urinary
most often causes diskospondylitis in tract infections.
dogs. Other frequently documented Bacterial endocarditis is also sus-
bacterial pathogens include Strepto- pected to be a primary source of in-
coccus species, Brucella canis, and Es- tervertebral disk infections in some
cherichia coli.5 Less frequently isolated dogs. This is a rare cause of disko-
bacteria are Pasteurella, Proteus, spondylitis, and the clinicopathologic
Corynebacterium, Actinomyces, No- syndrome associated with endocardi-
cardia, Bacteroides, and Mycobac- tis is usually more severe than that
terium species. The fungi Aspergillus associated with diskospondylitis
and Paecilomyces species have also alone.2
been cultured.6 Vertebral infections Dental disease has also been im-
caused by grass awn migration (see plicated in the pathogenesis of
below) are often associated with hematogenous bacterial diskospon-
mixed bacterial infections. Actino- dylitis. A wide variety of bacteria
myces species are common isolates in constitute the normal gingival flora in
cases of grass awn migration. Other dogs. In people, transient bacteremia
organisms such as Streptococcus occurs spontaneously during mastica-
species, Staphylococcus species, Bac- tion. In one study of diskospondylitis
teroides species, Proteus mirabilis, in dogs, moderate to severe peri-
Pasteurella species, and Pseudomonas odontal disease observed in the dogs
species frequently accompany Actino- was implicated as a possible source
myces species in these infections.6,7 of infection.8

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Canine diskospondylitis (cont’d)

Factors such as immunosuppres- force to cause microscopic bone frac- metaphysis may be unable to with-
sion, spinal trauma, and foreign tures, as has been seen in people. stand a bacterial insult in part because
body migration appear to play im- Microfractures, localization of bacte- of the arrangement of this vascular
portant roles in the pathogenesis of ria, and subsequent compromised network.5 The capillary loops at the
diskospondylitis. vascularity of the vertebral end plates epiphyseal plate are nonanastomos-
An immunologic study in Airedale in this area could provide a medium ing branches of the nutrient artery,
terriers suggests that decreased serum for bacterial growth.8,11 and obstruction by bacteria or mi-
concentrations of IgA in some dogs An infection in the paravertebral crothrombi tends to result in small
may impair their resistance to skin tissues and subsequent diskospondy- areas of avascular necrosis. Blood
and intestinal microflora.8 The im- litis and vertebral osteomyelitis are flow through the afferent capillary
munosuppressed condition of these most commonly caused by foreign loop is slowed and turbulent because
dogs probably contributes to the pen- body migration, especially grass of the disproportionate diameters and
etration of bacteria into the body and awns.4 These plant materials (e.g. numbers of vessels compared with
its subsequent spread to the disks. It wheat, barley, cheatgrass, foxtails) those in the efferent loops. The affer-
is not clear whether immunosuppres- usually have barbed ends that allow ent capillary loop also lacks phago-
sion in the dogs in the study was a them to move forward but not back- cytic cells, while the efferent loop
primary factor leading to disease or ward. Although the exact site of entry contains inactive phagocytic cells.
occurred subsequent to the infection. of grass awns is unknown, there are This results in a decreased resistance
Immunosuppression may predispose several theories. One proposed to bacterial colonization in the
German shepherds to diskospondyli- mechanism is that these plants may necrotic area.4 The circumferential
tis caused by Aspergillus species and migrate to the region of the vertebrae vessels surrounding the annulus fibro-
basset hounds to infection caused by after entering skin overlying the para- sus form numerous anastomoses with
Mycobacterium avium, though spe- vertebral structures or abdomen. the vascular components of the verte-
cific immunologic abnormalities have Muscular contractions may assist in bral bodies. Branches from these ves-
not been identified.2,8,9 grass awn migration. Penetration of sels penetrate the junction of annulus
Previous trauma to the cartilagi- these grass awns through the bowel and nucleus pulposus. This commu-
nous end plates, vertebral bodies, wall has also been suggested as a nicating venous plexus may allow in-
and intervertebral disks may con- portal of entry; however, evidence fection to spread to adjacent verte-
tribute to diskospondylitis develop- such as mesenteric scarring has not brae (Figure 1). The disk space itself
ment.6 Although trauma is not often a been documented. Inhalation of the is the initiation point for infections
reported cause of diskospondylitis, grass awn, with migration through only when direct inoculation with
the predominance of the disease in the lungs or mediastinum and then bacteria occurs.7 Once a vertebral in-
large-breed male dogs suggests that along the crura of the diaphragm, has fection is established, the spinal cord
stresses placed on the vertebral col- also been suggested as an entry and nerve roots may become in-
umn because of increased weight point. The crura of the diaphragm in- volved, leading to neurologic deficits
and activity may play a role.10 In sert on the ventral lumbar bodies of (Figure 2).
dogs, the thoracic and lumbar verte- L2 to L4. Grass-awn-associated disko-
brae and the L7 to S1 disk space are spondylitis and spondylitis occur Diagnosis
recognized as the most common sites most frequently at these vertebral
for diskospondylitis.8-11 Some consid- bodies, which supports the inhalation Signalment and clinical signs
eration must be given to the idea that theory of migration.6 Diskospondylitis primarily affects
venous and possibly arterial stasis In the vertebral column, infection large- and giant-breed dogs, although
occur at L7 to S1 as a result of vascu- first localizes in the cartilaginous end dogs of any size may be affected.12
lar occlusion on an intermittent basis plate, probably in the slowly flowing Males are affected twice as often as
during normal movement in dogs. venous channels.10 Nutrient capillaries females are. Affected dogs are most
The lumbosacral junction is a con- that supply blood to the bone loop often middle-aged, and German
centrated area of stress because of sharply at the epiphyseal plate before shepherds and Great Danes are rep-
the immobility of the pelvis. The entering a system of sinusoidal veins resented more frequently than are
stress of movement in these large- connecting to the medullary cavity. other breeds.10
breed dogs could generate enough Experimental studies suggest that the The clinical presentation of

674 SEPTEMBER 2002 Veterinary Medicine


FIGURE 1 FIGURE 2

Dorsal longitudinal ligament

Vertebral end plate

Vertebral body

1. A histopathologic specimen of a vertebral space with diskospondylitis. There is an


intense inflammatory reaction as well as symmetric erosion of the vertebral end plates.
Note the proximity of the annulus fibrosus and the vertebral body (hematoxylin-eosin
stain; 40). (Photograph courtesy of Dr. Roy Pool.)
2. A gross specimen of a vertebral space with bacterial diskospondylitis. There is lysis of
the vertebral end plates and spondylosis formation on the ventral aspect of the space.
The spinal cord contains an area of hemorrhage and swelling caused by instability
(arrow). (Photograph courtesy of Dr. William Maslin.)

Annulus fibrosus

diskospondylitis varies, but signs usu- function can develop over time with genitourinary infections may justify a
ally progress over a long period. The bone proliferation or occur suddenly spinal radiographic examination to
duration of signs observed by clients with rupture of the intervertebral rule out diskospondylitis.6 The physi-
most commonly ranges from several disk. Hemiparesis or hemiplegia can cal examination should also include
days to several weeks, but some af- result from nerve root involvement in examination of the ear canals, skin,
fected dogs have a longer course of patients with vertebral infection.5,10 and teeth; rectal palpation of the
disease lasting up to or longer than prostate in males; and thoracic aus-
one year. 7,12 Signs can vary from History and physical examination cultation to detect a heart murmur as-
those of systemic infection (e.g. de- You may discover a possible sociated with bacterial endocarditis.7
pression, anorexia, fever, weight source of bacteremia (e.g. pyometra,
loss) to those of musculoskeletal dys- prostatitis, pneumonia, bacterial en- Radiography
function (e.g. hyperesthesia, lame- docarditis) based on a patient’s his- Diskospondylitis, vertebral os-
ness, abnormal or stilted gait, reluc- tory and physical examination find- teomyelitis, vertebral physitis,
tance to ambulate). Neurologic signs ings. Dogs with involvement of other spondylosis deformans, and vertebral
are those of extradural compression, body systems are considered to have neoplasia alter the shape and ra-
paresis and ataxia, or paralysis and complicated diskospondylitis.3 Con- diopacity of affected vertebrae in dif-
depend on the vertebral site and sider a vertebral infection in any pa- ferent ways.13 The radiographic ap-
severity of the lesion. Hyperesthesia tient with paravertebral hyperesthesia, pearance of diskospondylitis only
along the spinal column is often seen especially in adult large-sized dogs. subtly differs from the appearance of
first and may be the only sign ob- Palpate the spine for any evidence of these other vertebral diseases (Table
served, although some dogs do not pain, and perform a thorough neuro- 1). The lumbosacral disk space (L7 to
exhibit pain or discomfort. In a study logic exam. In the absence of obvious S1) is the intervertebral disk space
of 32 dogs, 22 showed hyperesthesia spinal disease, clinical signs such as most commonly infected (Figure 3).
as a clinical sign.12 Neurologic dys- fever of unknown origin or recurrent Other common sites include the cra-

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Canine diskospondylitis (cont’d)

bodies in addition to the cartilagi-


TABLE 1 Radiographic Signs of Vertebral Diseases
nous end plates. The disk space may
be narrowed as a result of disk de-
Disease Radiographic Signs
struction. As the infection progresses,
Diskospondylitis Bony lysis of one or both vertebral end plates and, end plate erosion becomes more evi-
occasionally, the vertebral bodies dent, and the disk space appears
Bone proliferation on and within infected vertebrae widened because of lysis of adjacent
including ventral osseous proliferation bridging the bone (Figure 5). Late radiographic
affected disk space findings may include vertebral col-
lapse or fracture, scoliosis, and bony
Narrowing of the affected disk space
ankylosis.6,8,13,14
Reactive sclerosis in both vertebral bodies of affected
disk space Other diagnostic imaging
Vertebral Irregular and poorly marginated bony lysis affecting the Other types of diagnostic imaging
osteomyelitis vertebral body or other vertebral regions may be beneficial in diagnosing
diskospondylitis if radiography is not
Irregularly shaped periosteal reaction definitive.
Vertebral physitis Lucent widening of the caudal vertebral physis and loss of Myelography may be helpful
definition of physeal margins when a patient has marked neuro-
logic abnormalities and you are con-
Physeal collapse and sclerosis and remodeling of the
ventrocaudal portion of the vertebra sidering decompressive surgery.
Myelographic findings consistent
Spondylosis deformans Bony exostoses on the ventrolateral portion of the spine with extradural spinal cord compres-
Osteophyte formation at areas of ligament attachment sion include attenuation and dorsal
to the vertebrae deviation of the ventral contrast col-
umn over the affected disk space or
Bridging of the affected disk space with osteophytes
vertebrae.7,12
No bony lysis or sclerotic vertebral end plates Computed tomography (CT) may
Vertebral neoplasia Usually resides in one vertebra identify subtle end plate erosion and
soft tissue swelling or abscess around
Destruction of cortical bone or collapse of the adjacent the vertebrae. In human and veteri-
disk space evident nary patients with diskospondylitis,
Bone production may be evident CT shows destruction of the vertebral
end plate, with irregularities or multi-
ple hypoattenuating holes visible on
nial lumbar area, T13 to L1, and C6 to onset of infection; thus, dogs may transverse views. If the infection has
C 7. Involvement of multiple disk have clinical signs and be radio- extended into the vertebral canal, a
spaces is seen occasionally. The tho- graphically normal.3,7,10 soft tissue density is seen in the
racic spine is predisposed to involve- The earliest and hallmark radio- epidural space. CT performed after a
ment of multiple disk spaces.3,10 In- graphic sign of diskospondylitis is myelographic examination clearly de-
fection usually spreads to adjacent lysis of the vertebral end plates (Fig- fines compression of the cord or
disks by diffusing through the multi- ures 4A & 4B). The lesion is typically nerve roots by granulation tissue, ab-
ple holes in the vertebral end a mixed destructive and proliferative scess, or bone impingement. CT is
plates.7,10 Studies involving more than lesion centered on the affected disk most useful when the results of a sur-
25 dogs from a variety of sources space. Diskospondylitis lesions origi- vey radiographic examination are
documented multiple lesions in 18% nate as symmetric lysis of the verte- normal or inconclusive.7
to 28% of patients.3 It is important to bral end plates with reactive sclerosis Magnetic resonance imaging (MRI)
note that the diagnostic lesions seen in both vertebral bodies and subse- provides useful information when
on spinal radiographs may not ap- quent symmetric spondylosis. Bony survey and contrast radiography are
pear until two to six weeks after the lysis occasionally affects the vertebral not definitive. It allows evaluation of

676 SEPTEMBER 2002 Veterinary Medicine


FIGURE 3 FIGURE 4A

FIGURE 4B FIGURE 5

3. Diskospondylitis occurs commonly in the lumbosacral


large areas of the vertebral column on abnormalities before bone lysis is evi- intervertebral disk space. In this lateral radiograph of
a single set of images, identifies in- dent on survey radiographs, and cer- the spine, lysis and bony proliferation are evident at the
lumbosacral junction (arrow).
fected tissue earlier than radiography, tain types of scans (gallium) are a 4A & 4B. Diskospondylitis affecting multiple disk spaces
and best determines the full extent of good way to document successful in the lumbar region. In Figure 4A, symmetric lysis and
infection. Less advanced lesions of treatment. These scans are not spe- reactive sclerosis of the vertebral end plates is evident
radiographically in both affected disk spaces (arrows). In
diskospondylitis may be missed on cific for infection and must be used Figure 4B, a dried bone specimen of the same dog
survey radiographs, but extension of in conjunction with other diagnostic shows bony destruction of the end plates and
the infection into the vertebral canal testing.7,14 spondylosis (arrows). (Photographs courtesy of Dr. Roy
Pool.)
may be apparent on MRI. MRI results 5. A gross specimen of a spine with diskospondylitis
of increased T2-decreased T1 signal Microbiology affecting multiple sites. Destruction of the cartilaginous
intensity and nonuniform contrast en- end plates and vertebral body is evident (curved arrow).
The affected disk spaces are narrowed. Infected tissue,
hancement of the disk space, sur- Blood culture necrosis, and spondylosis are evident on the vertebral
rounding soft tissues, and adjacent In cases of suspected diskospon- bodies (straight arrows).
vertebral end plates in question often dylitis, obtain blood samples asepti-
suggest an inflammatory or infectious cally from the jugular vein for both
process of the vertebral column.2,7,15 aerobic and anaerobic bacterial cul-
Nuclear scintigraphy (radionuclide ture. Multiple cultures can be done
bone scanning) typically identifies to ensure isolation of the causative

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Canine diskospondylitis (cont’d)

organism. More than one culture is sidered.6,7 Reserve surgical biopsy for derlying bone. These granulomatous
ideal but rarely done by clinicians, cases with extenuating circum- lesions may or may not be invading
which may account for the low per- stances, such as therapeutic failures.6 the subarachnoid space and the lep-
centage of isolated bacteria in prac- tomeninges of the spinal cord.16 On
tice. Bacterial blood culture results Brucella canis culture histopathologic study of biopsy sam-
are positive in about 40% to 75% of and serologic testing ples or tissues collected at necropsy,
affected patients.12,16 Test dogs with radiographic evi- increased numbers of plasma cells
dence of diskospondylitis for Brucella are seen, and marked sclerosis of the
Urine culture canis. Most dogs with concurrent B. lesion site is noted. Large foci of in-
Since urinary tract infections often canis infection are intact males, flammatory cells and necrotic debris
accompany diskospondylitis, always though it has been reported in intact are present, and increased osteoclas-
culture the urine. Sometimes the bac- females.18 Because of the zoonotic tic activity with bone resorption is
teria in the blood are also shed in the potential of B. canis, it is advisable to also seen.16
urine and can cause a positive cul- test all dogs with signs of diskospon-
ture result. Blood and urine culture dylitis. The principal abnormalities as- Treatment
often reveal the same organism. Ob- sociated with brucellosis are disorders
tain the urine sample by cystocente- of the reproductive tract; however, Medical treatment
sis. Urine culture results have been other organ systems may be affected. Diskospondylitis is usually treated
reported to be positive in about 25% Brucella canis-associated diskospon- medically, although surgical treat-
to 40% of affected dogs.6,16 Ideally, dylitis has been reported in dogs, but ment is performed in extensive
obtain culture results before initiating details regarding signalment, clinical cases. The key to successful treat-
antibiotic therapy. Fungal isolates can abnormalities, diagnostic criteria, and ment of diskospondylitis is proper
also be obtained by culturing the treatment are similar to those in dogs antibiotic therapy directed at the
urine sediment. Aspergillus terreus is with diskospondylitis caused by other causative organism for an appropri-
most often isolated, either by urine organisms. Brucella canis can be iso- ate amount of time (Table 2). Since
cultures or swabs of tissue from the lated from the blood and urine many of these patients are immuno-
affected disk space.17 In addition to through culture. Brucella canis has suppressed, bactericidal antibiotics
culture, urine sediment can be micro- also been isolated from bone at the are preferred.7 Until blood and urine
scopically examined for evidence of time of decompressive surgery. culture and sensitivity results are avail-
fungal hyphae.17,18 Demonstration of the organism by able, you can treat an animal empiri-
blood culture is considered definitive. cally, assuming the infection is due to
Needle aspiration and biopsy The test is rarely done because B. the most commonly isolated organ-
Percutaneous needle aspiration of canis is hard to isolate.18 ism in patients with diskospondylitis,
the disk space is a safe procedure to Serologic tests, such as the rapid- coagulase-positive Staphylococcus
obtain tissue for cultures and cyto- slide agglutination and tube aggluti- species.2,3 If an organism is not cul-
logic examination. The procedure re- nation tests, can be used for screen- tured, you can continue empiric ther-
quires general anesthesia and sterile ing. False negative results are rare apy if the animal is responding well.
preparation of the skin overlying the with both tests (1%),6 but false posi- Antibiotics effective for this purpose
entry site. Guide a spinal needle into tive results are common with both are first-generation cephalosporins or
the disk by using CT or fluoroscopy. tests. The agar gel immunodiffusion β-lactamase-resistant penicillins (e.g.
Introduce a small amount of sterile test is a more sensitive and specific cloxacillin sodium, oxacillin sodium,
saline solution, and immediately aspi- serodiagnostic test for brucellosis and amoxicillin trihydrate-clavulanate
rate several times to obtain tissue ma- should be done to confirm positive potassium). Clindamycin is also ef-
terial. Percutaneous needle aspiration results on other serologic tests.6,18 fective against coagulase-positive
is indicated for patients that do not Staphylococcus species. A trimetho-
respond to initial antibiotic therapy, Pathology and histopathology prim and sulfonamide combination
in cases of suspected neoplasia, or The vertebral lesions of disko- or chloramphenicol is less effective,
when the diagnosis is unclear. If cul- spondylitis on necropsy consist of but these drugs are also less expen-
ture results by needle aspiration are moderate to extensive necrosis of ar- sive and can sometimes be
negative, surgical biopsy can be con- ticular cartilage end plates and un- effective.2,6,7

678 SEPTEMBER 2002 Veterinary Medicine


Treat patients with fever, neuro- TABLE 2 Common Causative Organisms of Diskospondylitis
logic deficits, or rapidly progressing and Effective Antibiotics
signs with intravenous antimicrobials
for three to five days, followed by a Organism Antibiotic Dosage
course of oral antibiotics. Initial oral Staphylococcus species Cephalexin 20–30 mg/kg PO t.i.d.
antibiotics are appropriate for ani- Cefazolin 20 mg/kg IV, IM, SC q.i.d.
mals with mild clinical signs and Cloxacillin 10 mg/kg IV, IM, PO q.i.d.
slowly progressing disease.7 Continue Oxacillin 15–25 mg/kg PO t.i.d. to q.i.d.
therapy for at least six weeks; ther- Amoxicillin-clavulanate 12.5–25 mg/kg PO b.i.d. to t.i.d.
apy may need to be continued for up Streptococcus species Amoxicillin 20 mg/kg PO b.i.d.
to six months in some cases. Antibi-
otic treatment usually results in im- Brucella canis Enrofloxacin 10–20 mg/kg PO once a day
provement within four or five days. Doxycycline 25 mg/kg PO b.i.d.
Clinical signs such as spinal hyperes- Actinomyces species Penicillin G 100,000 U/kg IV, IM, SC q.i.d.
thesia and fever may resolve within
Aspergillus species Ketoconazole 10 mg/kg PO b.i.d. (dog)
five days of treatment, but neurologic
50 mg/kg PO b.i.d. (cat)
signs typically take longer to resolve.7 Fluconazole 5 mg/kg PO b.i.d. (dog)
If there is no improvement after 50 mg/kg PO b.i.d. (cat)
seven to 10 days of treatment, reeval-
uate the case.6 Corticosteroids are Escherichia coli Enrofloxacin 10–20 mg/kg PO once a day
contraindicated in animals with verte- Cefazolin 20 mg/kg IV, IM, SC q.i.d.
Cephalexin 20–30 mg/kg PO t.i.d.
bral infections. Administering non-
Amoxicillin-clavulanate 12.5–25 mg/kg PO b.i.d. to t.i.d.
steroidal anti-inflammatory drugs to Chloramphenicol 22 mg/kg PO, IV, SQ t.i.d.
provide analgesia, along with cage
rest, is useful in controlling signs of
pain and lameness in these cases.3 probably because of the intracellular gression of lesions. Monitoring these
A combination of tetracyclines and location of the bacteria.2,6,7,18 Neuter lesions radiographically allows you to
aminoglycosides has been recom- dogs with diskospondylitis caused by make decisions about the length of
mended to treat diskospondylitis B. canis to reduce the risk of spread treatment and the antibiotic em-
caused by B. canis.7,18 These dogs to other animals and people. In addi- ployed in treating the disease.19 Keep
have also been treated with a tetracy- tion to reducing sexual transmission in mind that radiographic monitoring
cline hydrochloride-streptomycin sul- of the disease, castration causes re- has some limitations. It could take
fate combination and with fluoro- gression of gonadal steroid-dependent two to four weeks after the infection
quinolones.7,18 The tetracycline and tissues that act as reservoirs for the resolves to see radiographic improve-
streptomycin combination is currently organism. Castration resolves or pre- ment. And extensive bony remodel-
recommended for treating canine vents clinical abnormalities associated ing can mask active areas of bony
brucellosis, with a 94% success rate with brucellosis, such as epididymitis, lysis. So it is prudent to extend ther-
reported in one study. 18 Fluoro- orchitis, and scrotal dermatitis. Also, apy for four to six weeks after radi-
quinolones achieve high therapeutic castration may reduce the risk of fam- ographic resolution of bony lysis.6
concentrations in neutrophils, ily member infection by genital secre- Obtain additional spinal radiographs
macrophages, and the prostate gland, tion. Counsel clients on the zoonotic four to six weeks after stopping the
where Brucella species organisms are potential of Brucella canis and the antibiotic therapy to confirm resolu-
concentrated. In addition, fluoro- health risks, particularly in pregnant tion of the bony lysis.
quinolones have good penetration women, children, or immunocompro- Although surgical removal of grass
into bone and have been advocated mised individuals.6,7,18 awns, combined with antibiotic ther-
for use in osteomyelitis, which makes Continue antibiotic therapy for a apy, is recommended in cases of
them an adequate alternative in minimum of six weeks.3 Perform ver- grass-awn-associated diskospondyli-
diskospondylitis treatment. Unfortu- tebral radiographic examinations tis, grass awn removal is not always
nately, there is a high rate of recur- every two to four weeks during treat- practical. Finding the grass awn is
rence of brucellosis after treatment, ment to monitor progression or re- difficult, and finding one does not

Veterinary Medicine SEPTEMBER 2002 679


Canine diskospondylitis (cont’d)

mean there are not others present. A The goal of surgical biopsy is to sponse to initial medical treatment.
strictly medical approach is much obtain tissue for culture, which will Even if an etiologic diagnosis is not
less invasive and has proved effective help you determine a proper course made, most dogs with diskospondyli-
in most cases. Actinomyces species is of therapy. tis and minimal neurologic deficits re-
a frequently isolated organism and Hemilaminectomy may be used to spond well to appropriate antibiotic
can be treated with penicillin. Some reduce spinal cord compression. therapy. Recurrence is always possi-
species of Actinomyces may form Hemilaminectomy is preferred over ble, especially in immunocompro-
cell-wall-deficient L-phase variants dorsal laminectomy since it is less mised patients. The prognosis for pa-
and are reported to respond poorly likely to destabilize the spine.7,19 tients with marked neurologic deficits
to ampicillin-type products. Other an- In rare cases of diskospondylitis is guarded, but sometimes these dogs
timicrobials that can be used are clin- unresponsive to medical treatment, respond favorably to treatment, so it
damycin, chloramphenicol in con- intradiskal débridement can be per- is still recommended. Diskospondyli-
junction with erythromycin, and formed to remove infected and de- tis due to B. canis often responds to
minocycline hydrochloride. Antimi- vitalized tissue. Spinal stabilization antibiotic therapy, but recurrence is
common, and af-
A medical approach to grass-awn-associated fected animals may
require periodic treat-
diskospondylitis is effective in most cases ment because of re-
lapse. Fungal infec-
and is much less invasive. tions may respond to
therapy, but recur-
crobials that are not often effective in is required if intradiskal débride- rence is common, and the prognosis
these cases include aminoglycosides, ment results in instability or if insta- is guarded.7
metronidazole, cephalexin, and bility was recognized on preopera- Patients with only spinal hyperes-
oxacillin.6 tive radiographs.19 thesia or hyperesthesia in combina-
Fungal causes of diskospondylitis Dorsal spinal plating, spinal sta- tion with ambulatory paresis have a
are rare but present a therapeutic pling, and vertebral body plating fair to excellent prognosis.7,19 Patients
challenge. Limited success has been have been described in a few cases with either of the above problems
achieved by using itraconazole, but of diskospondylitis to reduce com- that do not respond to an initial
clients must be informed that this pression of the spinal cord and nerve course of medication have a guarded
drug is expensive and may have to roots and to provide stability to the to favorable prognosis for responding
be given for prolonged periods. spine. These surgical techniques have to either a different medication or in-
Like bacterial diskospondylitis, the been only moderately successful.7,11,19 tradiskal débridement.19 If patients
duration of treatment is based on Surgical treatment by a distraction- have an acute onset of neurologic
the results of follow-up radio- fusion technique was successful in signs, evidence of extradural com-
graphic examinations.3,20 three cases of lumbosacral diskospon- pression, or nonambulatory para-
dylitis.11 The intervertebral space was paresis or tetraparesis, they have a
Surgical treatment spread with a bone spreader, and dis- guarded prognosis when treated sur-
Surgical treatment is rarely re- traction was maintained by placing a gically.10,19 If these patients have evi-
quired, since most animals with Steinmann pin.11 The procedure is dence of spinal instability, the prog-
diskospondylitis are treated success- followed by antibiotic therapy. Poten- nosis is guarded to poor.19
fully with appropriate medical ther- tial complications of the technique in-
apy. Indications for surgery are to clude pin breakage, pin migration, REFERENCES
collect samples through open biopsy and L7 spinous process breakage.11 1. Alexander, J.W. et al.: Vertebral os-
teomyelitis and suspected diskospondylitis in
when there is no response to medical an Atlantic bottlenose dolphin (Tursiops
therapy, to decompress the spinal Prognosis truncatus). J. Wildl. Dis. 25 (1):118-121;
cord in patients with substantial neu- The prognosis for patients with disko- 1989.
2. LeCouteur, R.A.; Child, G.: Diseases of
rologic deficits, and to stabilize the spondylitis depends on the etiology, the spinal cord. Textbook of Veterinary In-
spine if instability is contributing to results of the neurologic examination ternal Medicine, 4th Ed. (S.J. Ettinger; E.C.
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Pa., 1995; pp 629-656.

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3. Jaffe, M.H. et al.: Canine diskospondylitis. b. Spondylosis
Compend. Cont. Ed. 19 (5):551-555; 1997.
4. Walker, T.L.: Vertebral osteomyelitis and CE Q UESTIONS 2 CE hours c. Narrowed disk space
discospondylitis. Disease Mechanisms in d. Calcified disk material
Small Animal Surgery (M. Bojrab, ed.). Lea You can earn two hours of Continu- e. Vertebral fracture
& Febiger, Philadelphia, Pa., 1993; pp 971-
974. ing Education credit from Kansas
5. Budsberg, S.C.: Musculoskeletal infec- State University by answering the fol- 6. Which test is the most sensitive and
tions. Clinical Microbiology and Infectious lowing questions on canine disko- specific test for Brucella canis?
Diseases of the Dog and Cat (C.E. Greene,
ed.). W.B. Saunders, Philadelphia, Pa., 1990; spondylitis. Circle only the best an- a. Rapid-slide agglutination
pp 555-561. swer for each question, and transfer b. Tube agglutination
6. Moore, M.P.: Discospondylitis. Vet. Clin. your answers to the form on page c. Urine culture
North Am. (Small Anim. Pract.) 22 (4):1027-
1034; 1992. 696. d. Agar gel immunodiffusion
7. Thomas, W.B.: Diskospondylitis and e. Blood culture
other vertebral infections. Vet. Clin. North Article #1
Am. (Small Anim. Pract.) 30 (1):169-182;
2000. 1. What is the most commonly isolated 7. Which antibiotic is most effective
8. Turnwald, G.H. et al.: Diskospondylitis organism in cases of diskospondylitis in when used for empirical therapy of
in a kennel of dogs: Clinicopathologic find- dogs? diskospondylitis?
ings. JAVMA 188 (2):178-183; 1986.
9. Kornegay, J.N.: Diskospondylitis. Proc. a. Brucella canis a. Amoxicillin trihydrate-clavulanate
NAVC. Eastern States Veterinary Association, b. Streptococcus species potassium
Orlando, Fla., 1995; pp 239-240. c. Staphylococcus intermedius b. Tetracyclines
10. Kornegay, J.N.: Diskospondylitis. Cur-
rent Veterinary Therapy IX Small Animal d. Staphylococcus aureus c. First-generation cephalosporins
Practice (R.W. Kirk, ed.). W.B. Saunders, e. Escherichia coli d. Chloramphenicol
Philadelphia, Pa., 1986; pp 810-814. e. A or C
11. McKee, W.M. et al.: Surgical treatment of
lumbosacral discospondylitis by a distraction- 2. What are the most common sites for
fusion technique. J. Small Anim. Pract. diskospondylitis in dogs? 8. What is the shortest duration of antibi-
31:15-20; 1990. a. Cervical vertebrae otic therapy in cases of diskospondylitis?
12. Kornegay, J.N.; Barber, D.L.: Diskospon-
dylitis in dogs. JAVMA 177 (4):337-341; b. Cervical and lumbar vertebrae a. Two weeks
1980. c. Sacral vertebrae b. Three weeks
13. Walker, M.A.: The vertebrae. Textbook d. Thoracic and lumbar vertebrae and c. Four weeks
of Veterinary Diagnostic Radiology, 3rd Ed.
(D.E. Thrall, ed.). W.B. Saunders, Philadel- lumbosacral junction d. Six weeks
phia, Pa., 1994; pp 81-87. e. Coccygeal vertebrae e. Three months
14. Jiminez, M.M.; O’Callaghan, M.W.: Ver-
tebral physitis: A radiographic diagnosis to
be separated from discospondylitis. A pre- 3. Which breed is overrepresented in 9. In cases of grass-awn-associated
liminary report. Vet. Radiol. Ultrasound 36 diskospondylitis? diskospondylitis, which antibiotic is not
(3):188-194; 1995. a. Boston terrier effective?
15. Kraft, S.L. et al.: Magnetic resonance
imaging of presumptive lumbosacral disco- b. Greyhound a. Metronidazole
spondylitis in a dog. Vet. Radiol. Ultrasound c. German shepherd b. Cephalexin
39 (1):9-13; 1998. d. Great Dane c. Clindamycin
16. Kornegay, J.N.: Discospondylitis. Text-
book of Small Animal Surgery (D. Slatter, e. Both C and D d. Chloramphenicol
ed.). W.B. Saunders, Philadelphia, Pa., 1993; e. Both A and B
pp 1087-1094. 4. What is often the first and only clinical
17. Watt, P.R. et al.: Disseminated oppor-
tunistic fungal disease in dogs: 10 cases sign of diskospondylitis? 10. What is the prognosis in cases of
(1982-1990). JAVMA 207 (1):67-70; 1995. a. Paresis diskospondylitis with spinal instability?
18. Kerwin, S.C. et al.: Diskospondylitis as- b. Pain a. Good
sociated with Brucella canis infection in
dogs: 14 cases (1980-1991). JAVMA 201 c. Paralysis b. Excellent
(8):1253-1257; 1992. d. Lameness c. Guarded
19. Fossum, T.W.: Nonsurgical diseases of e. None of the above d. Fair
the spine. Small Animal Surgery. Mosby, St.
Louis, Mo., 1997; pp 1151-1154. e. Favorable
20. Dallman, M.J. et al.: Disseminated as- 5. Which is not a change observed on
pergillosis in a dog with diskospondylitis spinal radiographs in diskospondylitis?
and neurologic deficits. JAVMA 200 (4):511-
513; 1992. a. Lysis of vertebral end plates

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