Research Article - Clinical Investigation (2020) Volume 10, Issue 1
A retrospective study of Spondylodiscitis with clinical, imaging and therapeutic correlations
Spondylodiscitis (SD) is a potentially devastating and time-consuming infectious disease that affects the vertebra, vertebral discs, and adjacent structures. Risk factors include being in an immunocompromised state, intravenous drug use, the use of spinal instrumentation and surgery . It is a highly heterogeneous and rare disease that represents 0.15% to 5% of all osteomyelitis cases [1-3]. Men are three times more likely to be affected than women . Nowadays, the incidence rate is increasing due to the improved life expectancy of patients with chronic debilitating diseases, improved case ascertainment with imaging and the increasing migration of immigrants [1-6]. Diagnosis is usually made by a multidisciplinary team and is based on the evaluation of clinical, radiological, laboratory and microbiological findings. However, it is not unusual to have a delay of 2-12 weeks between diagnosis and treatment initiation . SD can be classified as granulomatous (tuberculosis, brucellosis and other mycobacterial pathogens) or pyogenic. There are three forms of dissemination: hematogenous spread from a distant septic focus, direct inoculation (either from surgery or trauma) and contiguity with an adjacent septic focus. Generally, the infection starts in the anterior portion of the vertebral body because of its rich arterial supply and then spreads through the medullary spaces, affecting the intervertebral disc by contiguity. It very frequently involves the lumbar and dorsal segments of the spine [1-7].
Introduction: Diagnosing Spondylodiscitis (SD) can be challenging in clinical practice with highly variable outcomes. The aim of this study is to retrospectively analyze the clinical, laboratory, imaging findings of patients with SD treated at our hospital between January 2017 and December 2018. We also evaluated the SD evolution during a short follow-up at 4 and 6 weeks. Methods: The epidemiological, clinical, microbiological, laboratory findings (White Blood Count (WBC), C-Reactive Protein (CRP) and Erythrocyte Sedimentation rate (ESR)), Imaging (CT/MRI) and treatment data of 38 patients with SD were studied retrospectively. The laboratory findings (CRP, ESR) and the CT/MRI examinations during the follow-ups at 4 and 6 weeks were evaluated. Based on imaging (CT/MRI) we divided SD into the following 5 types based on morphological features observed: spondylitis or discitis (ST/DS), SD, SD with paravertebral abscesses (SD-PA), SD with epidural abscess (SD-EP) and SD with paravertebral and epidural abscesses (SD-PEA). Results: The most common complaint was pain (95%) and the main comorbidity was septicemia (42%). Staphylococcus aureus was found in 45% of the cases. The WBC was elevated in 32% of the patients. Both the CRP and ESR decreased during the follow-up. SD was found in 31% of the cases, SD-PA in 26% of the cases, ST/DS in 19% of the cases, SD-PEA in 13% of the cases and SD-EP in 11% of the cases. At the follow-up at week 4, SD-PA, SD-EP and SD-PEA had decreased and were found respectively in 21%, 5% and 5% of the cases. In the follow-up at week 6, SD-PA, SD-EP and SD-PEA were found respectively in 10%, 8% and 3% of the patients. Conservative treatment with antibiotic therapy was applied in 63% of the cases. Surgical treatment was given to 21% of the patients and an interventional procedure was done on 16% of the patients. Conclusion: SD diagnosis and management continues to be based on a multidisciplinary approach. Re-imaging in the critical period of 4-6 weeks with the monitoring of systemic inflammatory markers can be a good follow-up strategy.