SAT0604 ANALYSIS OF INFECTIOUS SPONDYLODISCITIS: 20-YEARS DATA: EPIDEMIOLOGY, CLINICAL FEATURES, DIAGNOSIS AND TREATMENT
Authors: Lobna Ben Ammar, Ines Mahmoud, Aicha Ben Tekaya, Olfa Saidane, Rawdha Tekaya, Leila Abdelmoula
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Infectious spondylodiscitis is defined as an infectious disease involving intervertebral disks and adja- cent vertebral bodies. It is rare and difficult to diagnose due to its non-specific clinical features. <h3>Objectives:</h3> To study the clinical, microbiological, radiological, therapeutic and evolving of infectious spondylodiscitis. <h3>Methods:</h3> Retrospective monocentric study including patients diagnosed as spondylodiscitis and hospitalized in our department between January 1999 and December 2018. The diagnosis was based on clinical, biological, radiological and bacteriological data. <h3>Results:</h3> We included 107 patients. There were 58 men (54.2%) and 49 women (45.8%) with a mean age of 55 years [16–86]. Predisposing factors were found in 59 patients (55.1%): This was diabetes in 21.49% of cases, history of cancer in 2.8% of cases, hepatic disease in 5.6% of cases, a long-term corticosteroid in 1.8% of cases, recent spinal surgery in 0.93% of cases, visceral surgery in 3.73% of cases, extra-articular history of tuberculosis in 2.8% of cases and consumption of unpasteurized milk in 25.23% of cases. The approximate time from onset of symptoms to diagnosis was from 0.23 to 24 months (median 3 months). Back pain was the most common symptom. Impaired general condition was observed in 71% of cases, fever in 35.5% of cases and night sweats in 42.9% of cases. Radiculalgia was found in 42.9% of cases. A neurological deficit was noted in 16.82% of cases: motor deficit in 1.8% of cases, spinal cord compression in 1.8% of cases and Cauda equina <i>syndrome in 2.8%</i><i> of cases</i>. The inflammatory syndrome was found in 90.6% of cases. The lumbar spine was most affected (54.2%), followed by the dorsal spine (29.9%) and the cervical spine (8.4%). The spondylitis was multifocal in 19.6% and multi-stage in 15.8% of cases. Radiographs of the spine were abnormal in 83.1% of cases. CT and Spinal MRI was performed respectively in 60% and 78.8% of cases and showed paravertebral abscess in 63.5%, epiduratis in 54.2%, spinal cord compression 9.3% and vertebral ostelysis in 8.4% of cases. The causative microorganism was identified in 51 cases (47.66%): brucella in 21 patients, mycobacterium tuberculosis in 16 patient, and pyogenic germs in 12 patients. All of them received initially adapted antibiotics. Surgical treatment was performed in 8 patients. Most of the patients showed good response (71.9%). Disturbance of liver function due to treatment occurred in 8 cases with good subsequent evolution. Neurological complication occurred in 11 cases and sepsis occurred in 4 cases. And 4 patients were dead. <h3>Conclusion:</h3> The microbiological diagnosis of infectious spondylodiscitis is often difficult to establish and the disease requires prolonged antibiotic treatment. Early diagnosis is needed to avoid neurological complications associated with poorer long-term outcomes. <h3> Disclosure of Interests:</h3> None declared