Abstract
We aimed to describe the clinical features and outcomes of pyogenic spondylodiscitis and to identify factors associated with an unfavourable clinical outcome (defined as death, permanent disability, spinal instability or persistent pain). In our tertiary centre, 91 cases were identified prospectively and a retrospective descriptive analysis of clinical records was performed prior to binary regression analysis of factors associated with an unfavourable outcome. A median 26 days elapsed from the onset of symptoms to diagnosis and 51% of patients had neurological impairment at presentation. A microbiological diagnosis was reached in 81%, with Staphylococcus aureus most commonly isolated. Treatment involved prolonged hospitalisation (median stay 40.5 days), long courses of antibiotics (>6 weeks in 98%) and surgery in 42%. While this was successful in eradicating infection, only 32% of patients had a favourable clinical outcome and six patients (7%) died. Diabetes mellitus, clinical evidence of neurological impairment at presentation, a longer duration of symptoms and radiological evidence of spinal cord or cauda equina compression were independent factors associated with an unfavourable outcome. Our data indicate that spondylodiscitis is associated with significant morbidity and suggest that adverse outcomes may be predicted to an extent by factors present at the time of diagnosis.
Highlights
Pyogenic spondylodiscitis is defined as a serious infection of the intervertebral disc(s) and/or adjacent vertebrae, and for the purpose of this article incorporates both vertebral osteomyelitis and spondylodiscitis [1]
16 years or over), a radiological diagnosis of pyogenic spondylodiscitis and a bacterial aetiology confirmed by microbiological culture or a bacterial aetiology not confirmed but thought likely by the treating infectious diseases team
We identified 98 patients with pyogenic spondylodiscitis
Summary
Pyogenic spondylodiscitis is defined as a serious infection of the intervertebral disc(s) and/or adjacent vertebrae, and for the purpose of this article incorporates both vertebral osteomyelitis and spondylodiscitis [1]. It may occur due to haematogenous seeding during a bacteraemia, direct spread from an adjacent focus of infection or as a consequence of inoculation during spinal surgery [2]. The incidence of spondylodiscitis appears to be increasing Japan from 5.3 per 100,000 in 2007 to 7.4 per 100,000 in 2010) presumably due to a combination of population aging and advances in diagnostic tools [3,4]. There is a critical lack of information. Sci. Univariate Analysis p-Value 2 Outcome Univariate 0.017 * (n = 62)
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