Background Infectious spondylitis remains frequent in Tunisia and is a common reason for hospitalization in rheumatology. We report the experience of our rheumatology department in the diagnosis and management of infectious spondylitis.
Methods This is a retrospective study of 118 cases of infectious spondylitis observed between 1997 and 2015. The diagnosis was based on clinical, biological, radiological and bacteriological data.
Results Our population consisted of 76 men (64.4%) and 42 women (35.6%) with a mean age of 59.2 years [18–84]. A supporting ground was found in 27% of patients. This was diabetes in 17.8% of cases, extra-articular history of tuberculosis in 7.6% of cases, hemodialysis for renal failure in 2.5% of cases, recent spinal surgery in 3.4% of cases, visceral surgery in 2.5% of cases and a long-term corticosteroid in 1.2% of cases. Spinal pain was present in all cases and had an inflammatory rhythm in 89.8% of cases. Fever was observed in 48.3% of cases, night sweats in 27.1% of cases and impaired general condition in 50% of cases. Neurological signs, present in 55.9% of cases were: radiculalgia in 55.1% of cases, motor deficit in 20.3% of cases and spinal cord compression in 9.3% of cases. The inflammatory syndrome was absent in 10.2% of cases. Spinal MRI and CT performed respectively in 77% and 47.4% of cases showed an epidural in 52.5%, a soft tissue abscess in 34.7%, soft tissue infiltration in 27.9% and a root canal abscess in 14.4% of cases. The spondylitis was multifocal in 7.7% and multi-stage in 11% of cases. Affected levels were: lumbar spine in 66.6%, the thoracic level in 26.9% and the cervical level in 8.5% of cases. The germ was isolated in 53.5% of cases. The disco-vertebral biopsy (performed in 42.3% of cases) was contributory in 27.2% of cases. A puncture of a soft tissue abscess (formed in 14.1% of cases) was contributory in 85.9% of cases. Blood cultures were positive in 7.7% of cases. The urine culture had found the germ in 6.4% of cases and a skin sample in 1.2% of cases. Wright serology was positive in 20.5% of cases. These germs were: tuberculosis in 44.9% of cases, brucellosis in 20.5% and pyogenic germs in 29.5% of cases.
Conclusions The clinical presentation of infectious spondylitis is polymorphic and determination of the causative organism can be difficult. In our series, in most cases it was a spondylodiscitis -specific germ. Support by appropriate antibiotic therapy leads overall to a good clinical outcome. Neurological complications can regress, more rarely from is fatal.
Disclosure of Interest None declared