POS1154 CHARACTERISTICS OF SURGICALLY TREATED TUBERCULOUS AND BRUCELLAR SPONDYLODISCITIS
Authors: D. Khalifa, N. El Fani, R. Moncer, E. Toulgui, W. Ouanes, S. Jemni
Journal: Annals of the Rheumatic Diseases (2021)

Background: Although rare in most developed countries, tuberculous and brucellar spondylodiscitis are still frequent in the mediterranean countries. Management of spondylodiscitis may require a surgical intervention in cases of spinal cord or root compression, bone destructions and deformities, unsuccessfull medical treatment or large abcesses. Objectives: To study characteristics and outcome of surgically treated tuberculous and brucellar spondylodiscitis. Methods: Medical records of patients who were admitted into the physical therapy and rehabilitation ward immediately post surgery of the spine were retrospectively studied. The study included records from January 2010 to December 2020. Results: Twenty patients were diagnosed with tuberculous or brucellar spondylodiscitis for which they underwent surgery. The mean age of diagnosis was 49.7± 11.9 years. The sex ratio was 1:1. The diagnosis was delayed in 60% of the cases due to atypical presentations. Fatigue was reported in 45% of the patients, back pain in 60% of the cases, radicular pain in 15% of the cases, fever in 20% of the patients and abnormal gait in 60% of the cases. Tuberculosis was identified in 75% of cases and brucellar infection in 25% of the cases. On biology, elevated inflammatory markers were noted in 60% of the cases. Intradermal reaction for tuberculosis was positive in 9 patients while cultures allowed the diagnosis of tuberculosis in 1 patient. Wright serology test confirmed the diagnosis of brucellar infection in all 5 cases. In the remaing ones, vertebral biopsy or intraoperative samples allowed the diagnosis of the tuberculous spondylodiscitis. Cervical spine involvement was noted in 5% of cases, lumbar spine in 25% and dorsal spine in 30% of the cases. All patients recieved antibiotics and spinal immobilization. Surgery was indicated in 78.6% of cases for spinal cord decompression and in 21.4% of the cases for voluminous abcesses. Anterior approach was used in 7.1% of the cases and posterior approach in 92.9% of cases. 23.1% of the patients benifited concomitantly with spinal fusion surgery. Post operative success was immediately confirmed by recovery of normal gait in 15.4% of the patients. Complications after surgery were reported in 35.7% of the cases. They consisted in spinal instability in 60% of the cases, abcesses in 20% of the cases and the emergence of secondary articular localizations in 20% of the cases. 28.6% of the patients underwent a second surgery mainly to stabalize the spine. Before surgery, walking was impossible for 65% of the patients and 12 months after surgery only 30% of the patients couldn’t walk (p=0.001). 15.8% of the patients developed later on pressure ulcers and 45% of the patients were prescribed appropriate wheelchairs. Conclusion: Spinal surgery in tuberculous or brucellar spondylitis may be indicated if medical treatment is insufficient and especially if neurological complications occur. Surgery may be invasive with various complications but sometimes it could be the only option to treat a neurological deficit. References: [1]Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012; 36: 413–420. Disclosure of Interests: None declared.