Infectious Spondylodiscitis

Abstract

Backgrounds: Spondylodiscitis (SD), which encompasses vertebral osteomyelitis, spondylitis, and discitis, is a pathology lacking consensus on optimal management.Methods: This was a retrospective analysis of medical records of all patients with diagnosis of SD admitted in an infectious diseases department, over a 24-year period (1988Y2011). Demographic, clinical, etiologic, radiological, and therapeutic data were collected.Results: One hundred forty patients were enrolled, mostly male (63%), with mean age 57 years (range, 17Y83 years), with average hospital stay of 46 days (range, 1Y190 days). Most frequent complaints were pain (96%), fever (46%), and neurological impairment (26%). Average duration of symptoms was 4.5 months (range, 3 days to 48 months). Magnetic resonance imaging was the imaging technique more often performed, showing compatible abnormalities in 115 of 116 patients, with the lumbar vertebrae predominantly involved (55%). In 60% of cases, a definitive diagnosis was achieved (Brucella spp: 47; Staphylococcus aureus: 19; other bacteria: 11; Mycobacterium tuberculosis: 7; Candida albicans: 1). Etiology was presumed in 26% and undetermined in 14% of patients. Overall, the most prevalent was brucellar SD (39%), followed by tuberculous SD (24%) and pyogenic SD (23%). Most patients (96%) were managed medically, with regimens varying according to etiology and treatment response. Outcome was mostly favorable (82%), whereas 5% of patients died, and 10% were lost to follow-up. The remainder exhibited no clinical improvement.Conclusions: Results confirmed that an older population is mainly affected, and nonspecific manifestations lead to significant diagnostic delay. Prolonged antibiotherapy and targeted surgery appear to improve long-term prognosis. In Portugal, like other Mediterranean countries, brucellosis and tuberculosis were frequently implicated.