Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Abstract

Study Design Prospective clinical study. Purpose We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. Overview of Literature Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. Methods Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. Results Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. Conclusions Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum Creactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

Subacute Low Back Pain: infectious spondylodiscitis with epidural and psoas abscess

“…The clinical symptoms of infectious spondylodiscitis are nonspecific. [2][3][4] Fever is often missing, [2] laboratory findings can be mild. [2][3][4] Recognition of the condition is difficult and often delayed as a result of its rarity.…”

“…[2][3][4] Fever is often missing, [2] laboratory findings can be mild. [2][3][4] Recognition of the condition is difficult and often delayed as a result of its rarity. [2][3][4] In our case, with special regard to the bilateral psoas abscess, the bilateral paravertebral injections received by the patient a few weeks earlier, are strongly suspected as the root cause.…”

“…[2][3][4] Recognition of the condition is difficult and often delayed as a result of its rarity. [2][3][4] In our case, with special regard to the bilateral psoas abscess, the bilateral paravertebral injections received by the patient a few weeks earlier, are strongly suspected as the root cause. [5] According to literature, Staphylococcus aureus is the most frequent pathogen.…”

“…[5] According to literature, Staphylococcus aureus is the most frequent pathogen. [2,4] However, blood cultures are indispensible in order to identify the offending agent. They should be taken before starting antimicrobial therapy, to be able to give targed treatment.…”

“…Due to the adequate intravenous therapy which was started in time, our patient is on the road to recovery now. CRP is a reliable marker for monitoring response to treatment [2,4] and contrast-enhanced MRI is the modality of choice [2] to get a clear radiological picture. The follow-up MRI of our patient shows significant regression regarding the inflammatory signs, further treatment and clinical follow-up is needed.…”