CASES' DIAGNOSED WITH SPONDYLODISCITIS DURING THE YEARS 2010–2020. DIAGNOSIS, TREATMENT AND COMPLICATIONS

Abstract

Abstract Introduction Spondylodiscitis is a rare infectious pathology with high morbidity and mortality that affects the intervertebral disc and adjacent vertebrae. It is most commonly found in the lumbar spine. It is mainly caused by haematogenous dissemination. It is a diagnostic challenge because its main manifestation, low back pain, is a prevalent symptom in the population. Methods A retrospective study of patients diagnosed with spondylodiscitis between 2010–2020 (n=60) was carried out. Exclusion criteria (n=14): follow-up less than one year, previous spinal surgery, first year mortality. Measurements made in plain radiology. Statistical analysis STATA 15.2. Statistical significance p<0,05. Results Average age: 68.17 years, 55% were males, 45% were females. Risk factors analyzed: 26.09% of the patients had diabetes, 8.70% kidney disease, 6.52% rheumatism, 6.52% were PVDA; about smoking 10.87% were smokers, 17.39% ex-smokers and the 71.74% were non-smokers; 8.70% had prescriptions of immunosuppressants and 19.57% had cancer before or during this episode. 50% had previous infection (n=23); 34.78% had urinary infection, 13.04% had knee prosthesis, 8.69% had respiratory infection, endocarditis the 30.43%, 17.36% had another sort of infection. The average delay to diagnosis was 40.36 days (SD 37.68). Total duration of antibiotic therapy, including days of hospital stay and those which were ambulatory: 134 days (SD 129.96); duration of hospitalization: 43 days. Surgical treatment was performed in 15.56% of the patients. a spacer was the technique used in the 14.29% of the patients; although the fixation was used in the 71.42% of the patients, the majority was a posterior fixation with the 57.14%, the anterior fixation was only used in the 14.29%. The acute complications found in this study were in this order, abscess with nearly half of the patients (n=22), phlegmon (n=3), vertebral destruction (n=2) and meningitis (n=1). No differences were obtained in the angle of kyphosis after pathology (p. 052), no increase in complications due to surgery (p=0.62), no difference in the cure of patients with targeted treatment (p=0.57), nor with surgical treatment (p=0.95), nor in the percentage of cure with diagnostic delay (p=0.76). Conclusions Spondylodiscitis is a pathology with non-specific symptoms, which leads to diagnostic delay. The cure rate with medical treatment is high, but it is essential to identify the causal germ in order to initiate targeted antibiotherapy and avoid the appearance of complications and long-term sequelae.