DÄ internationalArchive39/2008Current Diagnosis and Treatment of Spondylodiscitis: Differential Diagnosis

Correspondence

Current Diagnosis and Treatment of Spondylodiscitis: Differential Diagnosis

Dtsch Arztebl Int 2008; 105(39): 674. DOI: 10.3238/arztebl.2008.0674b

Schilling, F

LNSLNS It would have been necessary to describe and specify the differential diagnosis, particularly as it proved to be impossible to avoid the clinically confusing ambiguity of this diagnosis in the title. The underlying problem was the assumption that the terms "spondylodiscitis" and also generally "osteomyelitis" and "spondylitis" exclusively imply bacterial or purulent pathogenesis and morphology, so that no other terms are needed for postinfectious (secondary) chronicity. This ignores the fact that non-bacterial (aseptic and sterile) primary chronic osteomyelitis, spondylitis, and spondylodiscitis exist—as rheumatologists have known for many years. In particular, "spondylodiscitis" has been recognized, at least since its detailed description in 1973 (1), as a noninfectious and nonbacterial symptom of Bechterew's disease and of spondyloarthritis (also known as spondyloarthropathy). This frequent and destructive complication is observed in affected motor segments of the spinal column and involves primary perivertebral tendinopathy. We identified abacterial osteomyelitis as "primary chronic osteomyelitis" in "chronic recurrent multifocal osteomyelitis" (CRMO) as an entity in patients of all ages. It was differentiated as part of the symptom spectrum of the „SAPHO syndrome“ (www.sapho-syndrom-crmo.de and Orphanet 2004, n >173). It has then been subjected to interdisciplinary analysis and the aseptic clinical course of the osteitis has been described as a plasma cell sclerotic process in three steps (2). About a third of all CRMO patients in all age groups develop clinically relevant involvement of the vertebral bodies. These cases of sterile spondylitis can then progress to spondylodiscitis. Thus CRMO is an important differential diagnosis for ankylosing spondylarthritis and one which has largely been ignored (3). DOI: 10.3238/arztebl.2008.0674b


Prof. Dr. med. F. Schilling
Klinische und radiologische Rheumatologie
Johannes-Gutenberg-Universität Mainz
Hebbelstr. 20, 55127 Mainz, Germany

Conflict of interest statement
The author declares that there is no conflict of interest in the sense of the guidelines of the International Committee of Medical Journal Editors.

The authors of the review article have chosen not to reply.
1.
Schilling F: Spondylitis ankylopoetica – Die sogenannte Bechterewsche Krankheit und ihre Differentialdiagnose. In Diethelm et al.: Handbuch der Medizinischen Radiologie 1974; 452–689.
2.
Schilling F, Schweden F: Die chronische rekurrierende multifokale Osteomyelitis im Erwachsenenalter: Adulte CRMO – Darstellung des osteosklerosierenden Prozesses anhand von vier eigenen Fällen mit Pustulosis palmo-plantaris. Osteologie 1997; 6: 171–91.
3.
Schilling F et al.: Wirbelsäulenmanifestationen der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO). Fortschr Röntgenstr 2002; 174: 1236–42.
1. Schilling F: Spondylitis ankylopoetica – Die sogenannte Bechterewsche Krankheit und ihre Differentialdiagnose. In Diethelm et al.: Handbuch der Medizinischen Radiologie 1974; 452–689.
2. Schilling F, Schweden F: Die chronische rekurrierende multifokale Osteomyelitis im Erwachsenenalter: Adulte CRMO – Darstellung des osteosklerosierenden Prozesses anhand von vier eigenen Fällen mit Pustulosis palmo-plantaris. Osteologie 1997; 6: 171–91.
3. Schilling F et al.: Wirbelsäulenmanifestationen der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO). Fortschr Röntgenstr 2002; 174: 1236–42.