AB0921 Infectious spondylodiscitis: epidemiological, clinical, paraclinical and therapeutic aspects. (15th June 2017) - Feki, A
Abstract : Background: Spondylodiscitis is an infection of a disc and the two adjacent vertebrae due to the introduction of a pyogenic, usually by the haematogenous route. It's quite a rare disease accounting for 2–7% of all cases of septic osteomyelitis [1, 2]. Objectives: To study the clinical, microbiological, radiological, therapeutic and evolving of infectious spondylodiscitis Methods: A retrospective descriptive study conducted over years in the department of rheumatology, including all patients with infectious spondylodiscitis. Clinical given were collected from paper patients records. Results: We included 67 patients. There were 38 men and 29women. The mean age was 55 years. The male to female ratio was 38:29.Risk factors of spondylodiscitis were observed in 19 patients. The approximate time from onset of symptoms to diagnosis was from 3 to 365 days (median, 132 days). Back pain was the most common symptom. Spinal syndrome was found in all patients. The most frequent location of spondylodiscitis was lumbar spine. Signs of spinal cord compression including paraplegia or paraparesis of the lower limbs were observed in 31 patients. Pachymeningitis was associated in 1 case. The paravertebral abscess was associated to the disc involvement in 23 cases. Epiduritis was associated in 21 cases. Plain radiography, performed in in the majority of cases (63 cases, 94%), demonstrated pathological pictures in 56 (83.5%) patients. MRI, performed in 60 (89.5%) patients, disease was in all patients. Pathogens were isolated in 43 (64.1%) cases. Tuberculosis was the most common cause. The leading causative agents in non tuberculousspondylodiscitis were: Staphylococcus aureus (8 isolates, 11.9%), brucella (7 isolates, 10.4%), Escherichia coli (2 isolates, 2.9%) and streptococcus B (1 isolates, 1.4%).Two microorganisms combined (mycobacterium tuberculosis and a pyogenic) was found in one case. Medical treatment was adapted to the prescribed seed. Surgical treatment was performed in 6 patients. After therapy, 59 (88%) patients had regression of symptoms, two patients had a permanent neurological impairment (paraplegia), one patient had recurrence of infection and one patient was dead. Conclusions: Infectious spondylodiscitis has been diagnosed with increasing frequency. It should be taken into consideration in differential diagnosis in patients with significant back pain and laboratory evidence of an acute inflammatory process, especially metastatic spinal disease or inflammatory spondyloarthritis References: Zimmerli W. Clinical practice.Vertebralosteomyelitis. N Engl J Med 2010 Mar;362(11):1022–9. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008 June;56(6):401–12. Disclosure of Interest: None declared