AB0900 ACUTE PARAPARESIS AS CLINICAL PRESENTATION OF VERTEBRAL OSTEOMYELITIS
Authors: Jorge Juan Fragio-Gil, Roxana Gonzalez Mazario, Jose Ivorra Cortés, Francisco Miguel Ortiz Sanjuan, Elena Grau García, Cristobal Pávez Perales, Marta De la Rubia Navarro, Inmaculada Chalmeta Verdejo, Luis Gonzalez Puig, Isabel Martínez Cordellat, Rosa Negueroles Albuixech, Cristina Alcañiz Escandell, Jose Eloy Oller Rodríguez, Elvira Vicens Bernabeu, Carmen Nájera Herranz, Inés Cánovas Olmos, María Tasias Pitarch, Eva Calabuig Muñoz, Miguel Salavert Lleti, Jose Andrés Román Ivorra
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Vertebral Osteomyelitis (VO) is an infectious disease that could produces neurologic complications such as paresthesia, limb weakness or even acute paraparesis (AP)<sup>1</sup>. <h3>Objectives</h3> To analyze the clinical characteristics of patients with VO with AP as clinical presentation. <h3>Methods</h3> Single center retrospective observational study including adult patients diagnosed of VO based on the combination of clinical presentation with either a definitive bacteriologic diagnosis and/or imaging studies, who had a clinical examination at diagnosis compatible with AP, from January 2010 to January 2019. ASIA score (American Spinal Injury Association) was registered at diagnosis and one year after. Clinical and radiological history of lumbar stenosis or disc herniation was considered as prior spine pathology. We considered deaths attributive to PVO those which were directly caused by the infectious picture and/or its complications during the next year after diagnosis. <h3>Results</h3> In 15 of 122 patients with VO (18.30%), AP was described on physical examination at admission. Basal demographic and clinical features are exposed in table 1. ASIA scores at diagnosis and 1 year after are showed in chart 1. Duration of pain prior to diagnosis had a median of 24 days (7.5, 55). C reactive protein showed a median value of 153mg/L (83.2, 217.57), higher results than in no AP group [85.5 (37, 144.9), p=0.05]. The region most frequently affected was dorsal spine (73.33%). Epidural abscess was detected in all the patients (100%) significative higher than in no AP patients (56.07%, p&lt;0.01). Similar results concerning vertebral destruction were observed (100% in AP group against 44.86% in non AP, p&lt;0.01) and cord compression (93.33% versus 23.36% respectively, p&lt;0.01). Eleven patients underwent CT guided biopsy (73.33%), culture positive in 33.33 of cases, with prior antibiotic exposure in five of them. Median exposure was 1.5 days (0, 4.25). In 6 patients, the picture was attributed to Gram+ (50%), in other 4 cases Gram- (33.33) and 2 cases of tuberculosis (16.67). Nine patients (60%) required further surgery and 3 patients (20%) died, slightly greater than in non AP group (10.28%) with no statistical signification, p=0.06. <h3>Conclusion</h3> Despite of being a well-known condition, VO is still an issue since 1-2 out 10 patients have a serious complication at diagnosis, such as AP. None of the basal characteristics analyzed acted as a risk factor, though AP group showed more proportion of prior spine pathology. No delay in diagnosis was noted on AP patients, but higher CRP value at diagnosis has been observed and predilection towards dorsal spine. Almost all patients tend to improve their ASIA scale, but in every case, some physical damage remain. More than a half required surgical procedure after diagnosis and mortality seems to be higher in this group. <h3>Reference</h3> [1] Berbari EF, et al. 2015Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015. <h3>Disclosure of Interests</h3> None declared