Abstract
Introduction
Spondylodiscitis is an infrequent pathology and may be overlooked in clinical practice. Diagnosis requires a high level of suspicion by physicians; a multidisciplinary approach is essential. The objective was to describe the incidence, risk factors, clinical characteristics, management and outcomes of patients with spontaneous spondylodiscitis.
Material and Methods
Medical records of patients treated for infectious discitis at a third level hospital in Bogotá, Colombia, between January 2003 and August 2014 were reviewed. Postoperative infections and vertebral osteomyelitis were excluded.
Results
Spontaneous spondylodiscitis was diagnosed and treated in 40 patients (mean age 60,8 years, 60% male, 40% female). Most patients presented with subacute pain, 25% with fever, one patient with hypoesthesia in both legs, normal physical exam was observed in 24% of patients and no patient had paresis/paralysis. Among comorbid diseases, type 2 diabetes mellitus was the most relevant (20%). Concomitant infection at diagnosis was present in 7.5% of patients. WBC count and PCR were the most frequent laboratory test and MRI the most performed radiological test being positive in all cases. Procalcitonine was assessed in 10% of patients. Lumbar segments were involved in 62,5% of patients. S. Aureus and S. Epidermidis were the most common isolated microorganism (10% of patients) 55% of patients received I.V. inhospital antibiotic for less than 1 month, followed by 2–6 weeks of oral antibiotics in 75% of patients. Linezolid, Rifampicin and Vancomycine were the most frequently used antibiotics (alone or in combination). 20% of patients underwent surgical treatment. Abscess was observed in 7 patients (17,5%) all of whom went to surgical treatment. 2 patients developed infectious endocarditis and 1 patient died. 8 patients presented recurrence of the disease. Mean inhospital length was 30 days.
Conclusion
Spondylodiscitis diagnose must be suspected in patients presented with persistent back pain and specific risk factors (i.e., Diabetes Mellitus, Immunosuppression). Appropriate images and laboratory tests (MRI, WBC count, PCR and procalcitonine) must be assessed to reach an early diagnosis and antibiotic treatment guided by causative organism. Surgical treatment must be considered in specific cases. Recurrence is not common and must be prevented.