AB0649 Challenges and characteristics of infectious spondylodiscitis of the cervical spine. (23rd January 2014) - Dridi, L.
Abstract : Background: Cervical infectious spondylodiscitis (ISPD) are rare; they represent 3-15% of spinal sites infections. Objectives: We aim to report epidemiological, clinical and radiological features of cervical (ISPD) and to determine their management and their outcome. Methods: We retrospectively reviewed records of all patients hospitalized for (ISPD) over a period of 13 years [1999-2012] and then we selected those who had cervical location. Results: One hundred and three patients were hospitalized for ISPD during the period of 13 years, ten of them (9.7%) had cervical localization. There were six men and four woman with a mean age of 50.4 years [31-79]. Predisposing factor was found in 2 cases: diabetes mellitus. The mean time to diagnosis was 3, 3 months and half. All patients complained of inflammatory neck pain. Three patients had radicular pain that was bilateral in 2 cases and unilateral in 1 case. Impaired general condition was reported in four cases and night sweats in 5 cases. On examination, the cervical spine was stiff in all cases. Retro-auricular fistulization was noted in 1 case. Fever was found in 3 patients. Neurological examination found signs of pyramidal irritation in 4 patients. One patient had rapidly developed paraplegia and another patient developed tetraplegia. Elevated inflammation parameters were found in 9 cases. The spinal MRI was performed in all cases, it confirmed the diagnosis of ISPD and showed the presence of paravertebral abscess (5 cases), epiduritis (5 cases), epidural spinal cord compression (2 cases) and intradural extension (1 case). C1-C2 level was involved in 2 cases. Concomitant localization in dorsal level (1 case) and in lumbar level (1 case) were seen. Discovertebral biopsy was necessary and succefully performed in 6 cases. Tuberculosis was the etiology in 7 cases. Diagnosis was made according to histological signs in 3 patients and to presumptive criteria in the 4 remaining cases. Brucellosis was the cause in 1 case. Pyogenic origin was retained in 2 cases, Staphylococcus aureus was isolated in blood cultures in 1 case. All patients received appropriate antibiotic treatment and had spinal immobilization. Three patients required surgical intervention. It was drainage of paravertebral abscess in 2 cases and decompression of the spinal cord by laminectomy in 1 case. One patient died after surgery. The outcome was favorable in all other patients. Conclusions: Cervical ISPD have a high risk of neurological complications. MRI allows lesions assessment. Quick management is mandatory to provide complications. Because of the location, cervical spondylodiscitis can represent a challenge in diagnostic and even in surgical treatment. Disclosure of Interest: None Declared