Spondylodiscitis -Current diagnosis and treatment

Abstract

Introduction/Objective: Spondylodiscitis is an inflammatory process, which simultaneously afflicts the intervertebral disc and body of vertebra. Increasing incidence of the disease is linked to the rising number of acquired immune deficiencies. The objective is to identify the most frequent symptoms, clinical and neurological findings in these patients, basic laboratory features, average disease duration, localization of the inflammatory process, etiology, outcome and sequelae. We also suggest a diagnostic algorithm and an adequate empiric antibiotic therapy as well as the necessary length of treatment. Methods: A retrospective study included 33 patients diagnosed with spondylodiscitis who were for the first time hospitalized at the Infectious Diseases Clinic of the Clinical Center of Vojvodina. We used descriptive statistics to identify the patients' demographic characteristics, clinical and laboratory indicators of inflammation, predisposing factors, the most frequent localization of the disease in respect to the spinal regions, as well as the use of appropriate diagnostic methods. We also noted the efficiency of the used combinations of antibiotics. Results: Most of the patients were male, aged between 31 and 65 years. 94% of patients had an increased sedimentation rate, 33% had high fibrinogen, 73% had high C reactive protein (CRP), while 27% had alpha 2 hyperglobulinemia. Lymphocytosis was noted in 42% of patients, and neutrophilia in 9%. The most common predisposing factor was previous surgery, which was registered in 24% of cases. The inflammation was most frequently localized in lumbosacral region (30%). MRI was successfully used to confirm the diagnosis in 91% of cases. 97% of patients were successfully treated with conservative therapy. Conclusion: There is a higher incidence of spondylodiscitis among men of working age. The disease has a predilection for lumbar and sacral region, and symptoms and clinical findings are non-specific. In most cases one cannot identify the causative agent; however, empiric combinations of broad spectrum antibiotics have proven to be adequate in majority of patients. MRI is the best imaging method to confirm the diagnosis of spondylodiscitis.