Spontaneous spondylodiscitis: presentation, risk factors, diagnosis, management, and outcome

Int J Infect Dis. 2009 Sep;13(5):564-9. doi: 10.1016/j.ijid.2008.08.025. Epub 2008 Dec 13.

Abstract

Background: Spontaneous spondylodiscitis is an uncommon disease, which may result in serious complications with potentially high morbidity and mortality. We conducted a prospective case study over a 2-year period in order to analyze the clinical features, approaches to management, and outcome of spondylodiscitis.

Methods: Eight consecutive patients (four men, four women; age range 53-82 years) suffering from spondylodiscitis were identified during the study period. Parameters recorded included: demographics, past medical history, predisposing factors, presenting signs and symptoms, spinal level and extension of the infection, laboratory indices of inflammation, microbiological testing, radiological assessment, kind and duration of treatment, follow-up magnetic resonance imaging (MRI) studies, and outcome.

Results: Duration of symptoms varied from 14 to 90 days. All patients had back pain; fever>or=38 degrees C was present in 5/8 (62.5%) and neurological findings in 6/8 (75%). Diabetes mellitus was identified in six (75%). Most of the patients had elevated laboratory markers of inflammation. At the initial MRI, 12 anatomical levels were found. The microorganism was identified in 7/8 by blood or bone marrow cultures (50% Staphylococcus aureus). None of the patients underwent surgical intervention. Seven patients (87.5%) recovered to full activity; follow-up MRI study results were not always in parallel with the clinical improvement of patients.

Conclusions: Spontaneous spondylodiscitis should be considered in every patient with back pain accompanied by fever and laboratory markers of inflammation. The major predisposing risk factor seems to be uncontrolled diabetes. MRI appears to be the method of choice for confirming diagnosis. Timely and accurate diagnosis along with prompt administration of antibiotics appears mandatory for a favorable outcome and avoidance of surgical intervention.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Back Pain
  • Diabetes Complications*
  • Discitis* / diagnosis
  • Discitis* / diagnostic imaging
  • Discitis* / drug therapy
  • Discitis* / physiopathology
  • Female
  • Fever
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Radiography
  • Risk Factors
  • Spine / diagnostic imaging
  • Staphylococcal Infections* / diagnosis
  • Staphylococcal Infections* / diagnostic imaging
  • Staphylococcal Infections* / drug therapy
  • Staphylococcal Infections* / physiopathology
  • Staphylococcus aureus* / drug effects
  • Staphylococcus aureus* / isolation & purification
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents