Background Infectious spondylodiscitis is characterized by infection involving the intervertebral disc and adjacent vertebrae. Smaller studies indicate that the incidence of spondylodiscitis is increasing, possible related to expanding elderly and immunocompromised populations, the increasing use of invasive spinal procedures and the use of immunosuppressive therapies.
Objectives The aim of this study is to determine the epidemiological, clinical, radiological and bacteriological characteristics of spondylodiscitis in Tunisia.
Methods A retrospective study including patients diagnosed as spondylodiscitis in the Rheumatology department between 1995 and 2013. The diagnosis was established basing on bacteriological features or a set of presumption arguments.
Results Forty one patients are included in this study. There were 21 males and 20 females. The mean age was 61.66 years, ranged from 25 to 89 years. Predisposing factors were found in 17 patients (41%): diabetes in 8 cases, long-term corticosteroid for chronic inflammatory rheumatism in 4 cases, cirrhosis in 2 cases and chronic renal failure in 3 cases. Duration of symptoms varied from 20 to 90 days. All patients presented with back pain. Fever was noted in 38 cases. A neurological deficit was noted in 7 patients. An increase of erythrocytes sedimentation rate and C-reactive protein was noted in 87% of cases (n=36). Spine X-ray showed a disc space narrowing and irregularity of the end-plates in 39 cases. Lumbar region was the most common infection sites (58%) followed by dorsal spine (32%) and cervical spine (10%). A multi stage spondylodiscitis was found in 4 cases.
Only 27 patients had MRI showing epiduritis in 12 patients and paravertebral abscess in 8 patients. Spndylodiscitis was associated with a septic arthritis in one case and Tuberculosis spondylodiscitis was associated with hepatic tuberculosis in another case.
The causative microorganism was identified in 25 cases (61%): staphylococcuc in 4 cases, Gram negative germ in 5 cases, streptococcus in 3 cases, mycobacterium tuberculosis in 12 cases and brucella in 4 cases. Multi-bacterial spondylodiscitis was found in 2 patients.
All patients underwent initially adapted antibiotics and immobilization leading to recovery in 73% of cases (n=30). Seven patients were lost during follow up. Neurological complication occurred in 3 cases and sepsis in 1 case.
Conclusions Infectious spondylodiscitis necessitate a high index of suspicion in a patient presenting with significant back pain and laboratory evidence of an acute inflammatory process. The diagnosis is based on symptoms, clinical findings, and imaging and laboratory results. MRI remains the most sensitive radiological examination for early detection of spondylodiscitis. Identifying the germ incriminated in infectious spondylodiscitis is imperative. Early diagnosis is necessary to avoid life threatening complications and neurological squeals.
Lucy Cottle, Terry Riordan. Infectious spondylodiscitis. Journal of Infection 2008; 56: 401–412
Disclosure of Interest : None declared