Early Diagnosis and Multi-Modal Management of Patients with Spondylodiscitis

Abstract

Background:Spondylodiscitis, also known as vertebral osteomyelitis or bacterial spondylitis, is the most common spinal infection, which affects the intervertebral disc, adjacent vertebral bodies, and occasionally also the posterior elements of the spine. The goals of management of spondylodiscitis is to relieve pain, control infection, prevent or reverse neurological deficit, maintain stability of the spine and to prevent recurrence of the infection. Spondylodiscitis can be managed either by conservative treatment, or by surgical intervention.

Aim of the study: The aim of this study was to get the best management for patients with spondylodiscitis.

Patients and methods:This study included 18 consecutive patients with spondylodiscitis and divided equally into conservative treated group and surgical group. All patients underwent full history taking, clinical evaluation, pain visual analogue scale, Oswestry Disability Index, laboratory investigations and radiological. The patients who were suitable candidates for the study were treated conservatively by antibiotics according to culture and sensitivity, analgesics, muscle relaxants and neurotonics. Surgical treatment was done for some patients who fulfill surgical criteria. Follow up was done 1 week after management by inflammatory markers and after 3 weeks using x ray and CT and assessment of patient satisfaction after treatment by Odom’s criteria.

Results:The mean age of the studied patients in conservative treated group was 47.33 years. Spontaneous spondylodiscitis was 66.7% and postoperative spondylodiscitis were 33.3%. End plate erosion was 88.9% of the studied cases. The level of infection was moistly at lumber (55.6%) and lumbosacral (22.2%) at L3, L4 and L5 were (33.3%, 55.6 %and 44.4 %) respectively.

There was significant decrease in the pain severity and VAS and in postoperative compared with preoperative assessment. ODI of disability showed significant lower postoperatively with minimal disability (88.9 %) compared to preoperative treatment. There was significant improvement in the levels of WBCs, ESR and CRP in postoperative treatment compared to preoperative assessment which were 12.54 10³/mm³, 38.77 mm/hr and 26.22 mg/mL versus 18.82 10³/mm³, 97.66 mm/hr and 57 mg/mL. Complication of treatment was 11.1% and duration of antibiotic ttt (days) was 100.88. Hospital stay was 1.66 (days) and follow-up duration was 4.27 (months).

The mean age of our studied patients in surgical group in our study was 48.55 ± 11.37 years. Spontaneous spondylodiscitis was 66.7% and postoperative spondylodiscitis were 33.3%. Back pain and neurologic compromise were 55.6% and 66.7%.  End plate erosion was 77.8% and vertebral body destruction was 66.7%.

Level of infection was L4 and L5 lumber and sacrolumber were 55.6% and 11.1%. Bacteriological findings of wound discharge and biopsy showed that 66.7% was pyogenic infection, 11.1% was non-pyogenic and 22.2% was mycobacterium tuberculosis.

There was significant decrease in the pain severity (77.8% was mild pain) and VAS (score 2 and 3 were 33.3% and 33.3%) and in postoperative compared with preoperative assessment. ODI of disability showed significant lower postoperatively with minimal disability (66.7%) compared to preoperative cases. There was significant improvement in the levels of WBCs, ESR and CRP in postoperative treatment compared to preoperative assessment which were 13.10 10³/mm³, 43.77 mm/hr and 32.66 mg/mL versus 18.70 10³/mm³, 106.88 mm/hr and 57 mg/mL. Complication of treatment was 11.1% and duration of antibiotic ttt was 85.33 (days). Hospital stay was 5.44 (days) and follow-up duration was 4.05 (months). Outcomes of superficial wound infection was one case only.

Conclusion: Spondylodiscitis surgery group showed better late clinical outcomes after one year and slightly higher complication rate throughout the follow-up duration, although it had no significant differences compared with conservative group post-treatment