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3 - Retrospective evaluation of spontaneous pyogenic sponydylodiscitis cases hospitalized in Our clinic
Dilek Yildiz Sevgi, Alper Gunduz, Ahsen Oncul, Osman Tanriverdi, Ahmet Sanli Konuklar, Aziz Ahmad Hamidi, Murat Musluman, Nuray Uzun, Ilyas Dokmetas
Objective: Spondylodiscitis is the infection of the intervertebral disc and the adjacent vertebral bodies. Pyogenic Spondylodiscitis often develops following spinal surgery, spontaneous pyogenic spondylodiscitis is rare. Delay in diagnosis due to the absence of specific findings may lead to high morbidity and mortality. In this case series, we aimed to evaluate clinical features, predisposing factors, treatment and results of patients with spontaneous spondylodiscitis followed at our clinic within five years period.
Material and Methods: Between 01.01.2007-31.12.2014, files of thirteen consecutive patients diagnosed with spontaneous pyogenic spondylodiscitis and hospitalized in our clinic were studied retrospectively. Diagnosis was based on clinical presentation, laboratory findings like increased white blood cell count, erythrocyte sedimentation rate, C-reactive protein as an evidence of inflammation and also blood or biopsy culture results and magnetic resonance imaging findings consistent with the diagnosis.
The demographic characteristics, history, predisposing factors, laboratory and radiological data, microorganism and treatment response of patients were evaluated.
Results: Among the patients eight were male and five female. Ages ranged between 19-87. (Mean: 61) All patients suffered from back pain. Nine patients had fever higher than 38°C, and eight patients had a nerve root compression. There were nine cases with diabetes mellitus, and three of these patients had uncontrolled diabetes mellitus. Three of the patients had end-stage renal disease undergoing dialysis. Duration of symptoms before establishing the diagnosis ranged between 15-180 days.
S. aureus was the most common isolated microorganism. All S. aureus isolates were methicillin-sensitive. One of our cases was accompanied by S. aureus meningitis. The affected areas in eight cases were thoracic and and in five cases lumbar vertebra. Treatment was cefazolin in seven patients with MSSA, cefepime in patients with concomitant meningitis and ampicillin sulbactam in one patient with renal failure. One of the cases with isolated Enterococcus spp was treated with ampicillin sulbactam and one with teicoplanin. Patients with isolated Klebsiella spp were treated with levofloxacin. Four patients underwent surgical drainage. All patients responded to treatment.
Conclusion: Spontaneous pyogenic spondylodiscitis is a rare disease. However, in all patients with acute or subacute back pain the diagnosis should be considered particularly in patients with diabetes mellitus or advanced age. Early diagnosis is essential for high cure rate with appropriate medical treatment and surgical intervention if needed.
Keywords: Discitis, pyogenic, spontaneous spondylodiscitis
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