Abstract
Objective:Infectious spondylodiscitis (SD) is an infectious disease that is rare and difficult to diagnose due to its non-specific clinical features. In this study, we aimed to describe the clinical and diagnostic features of infectious spondylodiscitis.Methods:All patients who were diagnosed with SD at our hospital during a 7-year period from January 1, 2011 through December 31, 2017 were included in the study. Spondylodiscitis is divided into the following three types: pyogenic, tuberculous, and brucellar. Clinical and laboratory data were collected retrospectively from the medical records of the patients.Results:Of the 118 patients, 66 (55.9%) were female, 81 (68.6%) had pyogenic SD (PSD), 21 (17.8%) had tuberculous SD (TSD), and 16 (13.6%) had brucellar SD (BSD). The mean age was 59.3 ± 14.6 years. Leucocytosis was significantly higher in patients with PSD (p=0.01) than in patients with other types of SD. Thoracic involvement (47.6%) was significantly higher in patients with TSD (p=0.005) than in other patients. Sacral involvement (12.5%) was significantly higher in patients with BSD (p=0.01) than in other patients. Paravertebral abscess formation (42.8%) occurred most frequently in patients with TSD. Microbiologic agents were defined in 50% (18/36) of the surgical specimens and in 12.5% of the fine needle aspiration biopsy (FNAB) specimens. Staphylococcus aureus was the most common microbiological agent in patients with PSD. Spinal surgery was defined as a risk factor for PSD (p = 0.0001). Binary logistic regression analysis revealed that female gender, thoracic involvement and night sweats were the predictive markers for TSD (OR 4.5 [95% CI 1.3-15.3] and OR 5 [95% CI 1.7-14.6]).Conclusion:PSD is the most frequent form of SD. Leucocytosis is most common in patients with PSD. Thoracic involvement and paraspinal abscess were prominent in patients with TSD. Sacral involvement was most common in patients with BSD. Thoracic involvement, female gender and night sweats were the predictive markers for TSD. The microbiological culture positivity rate was higher in surgical specimens compared to FNAB specimens. The need for surgical treatment was most common in patients with TSD.
Highlights
Infectious spondylodiscitis (SD) is defined as an infectious disease affecting the vertebral body, the Correspondence: May 26, 2018 June 28, 2018 October 29, 2018 October 31, 2018 intervertebral disc, and/or adjacent paraspinal tissue.[1]
Night sweats were more common in patients with brucellar SD (BSD) (25%) and tuberculous SD (TSD) (19%) than in those with pyogenic SD (PSD) (1.2%)
Leucocytosis was significantly higher in patients with PSD than in those with TSD and BSD (p=0.01), which was similar to the results of other studies[13,14] We found that there was no difference in the means of ESR and CRP among the three groups (p=0.36; p=0.72, respectively)
Summary
Infectious spondylodiscitis (SD) is defined as an infectious disease affecting the vertebral body, the Correspondence: May 26, 2018 June 28, 2018 October 29, 2018 October 31, 2018 intervertebral disc, and/or adjacent paraspinal tissue.[1] rare, SD is the main manifestation of haematogenous osteomyelitis in patients older than 50 years of age.[2] Its incidence seems to be increasing as a result of the increase in spinal instrumentation and surgery and with a higher life expectancy of older patients with chronic debilitating diseases.[3,4]. The clinical diagnosis is still a challenge. The symptoms and clinical signs of patients may be nonspecific, and early diagnosis may be difficult. Back pain is the most frequent initial symptom of SD, followed by fever. Neurological deficits are less common.[3,5,6] Predisposing factors for SD are
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