Pos1289 analysis of Infectious Spondylodiscitis: Five-Years Data

Abstract

BackgroundSpondylodiscitis (SD) is an infection of the vertebral body or disc and may also extend to the epidural space, posterior elements, and paraspinal soft tissues. It is a cause of morbidity and mortality. However, the diagnosis is often delayed because of the non-specific clinical features.ObjectivesIn this study, we aimed to describe the clinical and diagnostic features of infectious SDMethodsWe conducted a retrospective study including 40 cases of infectious SD, performed over a period of five years (2014-2019). Epidemiological, clinical characteristics, laboratory results and imaging findings were uniformly collected.Results: Of the 40 patients, 37.3% were male. The mean age was 53.3 ± 13.9 years [28-83] and the median Charlson Comorbidity Index was 1. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The median duration from onset to diagnosis was 41 days [8-300]. Low back pain (LBP) was the most common symptom (98%). Lumbar spine was the most frequent location (71%). Seven patients had contiguous multiple levels (>2 vertebral bodies). Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 15 patients. The median erythrocyte sedimentation rate was 54 mm/1st h [13-223], the median CRP was 26.3 mg/L [7-387]. Leukopenia (<4000 WBCs/mm3) was found in three patients (9.8%). Magnetic resonance imaging confirmed the diagnosis in all cases, and revealed spinal epiduritis in 17 patients (34.8%), paravertebral abscesses in 11 (20.3%) and spinal cord compression in 4 (7.8%). Pathogens were isolated in 19 cases. Computed tomography-guided percutaneous disc biopsy (PDB) was performed in 16 (53.5%) and was conclusive in (11/15) cases (66.8%). Mycobacterium tuberculosis (MT) was the most common pathogene (46.4%) followed by Brucella (21.4%), Pyogenes (17.8%) and Gram-negative bacteria (14.2%). One patient had both MT and Staphylococcus haemolyticus.Paravertebral abscess formation (19.6%) occurred most frequently in patients with tuberculous SD (P= 0.02). Leucocytosis (>10,000 WBCs/mm3) was significantly higher in patients with Pyogenes SD (p=0.002) than in patients with other types of SD. All patients were treated with antibiotics and only one patient underwent surgical act. The outcome was favourable in 27 cases (86.8%).ConclusionSpondylodiscitis should be considered for all patients presenting with chronic backpain especially when associated with laboratory examination abnormalities. In our study, tuberculous spondylodiscitis was the most frequent, which highlights the fact that osteoarticular tuberculosis remains endemic in developing countries, where it still constitutes a major public health problemDisclosure of InterestsNone declared