Background Tuberculosis is enjoying a resurgence of interest, due to its current resurgence in the world. Osteoarticular location represents 3-5% of tuberculosis cases. Spondylodiscitis constitutes the most frequent location.
Objectives The objective of our study was to describe the biological, therapeutic, clinical and radiological aspects of tuberculous spondylodiscitis.
Methods This is a retrospective study of 35 cases of tuberculous spondylodiscitis collected in the Department of Rheumatology over a period of 15 years [1998-2013].
Results Our population consists of 14 men and 21 women with a sex ratio of 2/3. The mean age was 58.5 years [18-83]. Comorbidities noted were diabetes (n=4), renal failure (n=1) and systemic corticosteroid therapy (n=1). A history of tuberculosis was present in 4 patients. The circumstances of discovery were inflammatory spinal pain in 33 cases associated to general signs such alteration of the general state (n=22) and night sweats (n=11). Fever missing in 16 patients. Neurological impairment was objectified in 20 patients. Radicular pain was the most common manifestation. It was lumbosciatica (n=9), intercostal neuralgia (n=4), cruralgia (n=4) and cervico-brachial neuralgia (n=3). Motor deficit was objectified in 9 cases and vesicosphincteric disorders were noted in 4 patients. An array of spinal compression occurred in 6 cases. The mean disease duration was 8 months and a half. The biological inflammatory syndrome was absent in 2 cases. Plain radiographs were normal in 5 cases. CT performed in 22 cases and MRI performed in 25 cases showed an epiduritis in 18 cases, an infiltration of the soft parts in 12 cases, a soft parts abscess in 15 cases and root canal abscess in 7 cases. Spondylodiscitis was multistage in 4 cases and multifocal in 5 cases. Mycobacterium tuberculosis was isolated in 13 cases via a disco-vertebral puncture biopsy (n=5), via a puncture abscess (n=6), and a levy from another location (n=2). The tuberculous origin was retained in other cases based on clinical and radiological data. All patients were put on anti tuberculosis treatment. Surgery was required in 7 cases. The surgery was a decompressive laminectomy in 4 cases, a drain abscess in one case and the combination of two acts in two cases. The evolution was unfavorable in 2 cases with persistence of neurological sequelae. A case of vasculitis secondary to anti tuberculosis treatment was noted.
Conclusions Tuberculous spondylodiscitis has often an insidious development which is causing a delay in diagnosis. Isolation of Mycobacterium tuberculosis is difficult. The diagnosis is often based on a beam of arguments.
Disclosure of Interest None declared
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