Infectious spondylodiscitis: A twenty-year experience from a single tertiary referral center

Aim of the work: To study microbiological, clinical and therapeutic aspects of spondylodiscitis (SD) and predisposing risk factors in Tunisian patients. Patients and methods: Patients with SD admitted to Rheumatology Departments, Southern Tunisia, were retrospectively studied. Medical records were reviewed over the last 20-years and investigations included bacterial cultures, magnetic resonance imaging (MRI) or computed-tomography percutaneous disc biopsy (CT-PDB). Results: There were 67 SD cases (incidence of 0.17/100,000 inhabitants/year); 38 men and 29 women and mean age was 55 ± 16 years. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The duration from onset to diagnosis was 133.6 ± 115 days. Low back pain (LBP) was the most common symptom. Lumbar spine was the most frequent location. Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 31 patients. C-reactive protein was elevated in 54 (52.17 ± 43.97 mg/L). MRI showed abnormalities in 60 patients and CT-PDB was performed in 39. Pathogens were isolated in 43 cases. Mycobacterium tuberculosis (MT) was the most common (55.8%) followed by staphylococcus aureus (18.6%), brucella (16.3%), Escherichia coli (EC) (4.7%) and streptococcus-β in 1 patient; 1 patient had both MT and EC. Medical treatment was prescribed in 91% and surgery performed in 6. 88% of patients improved after 24 months follow-up. Conclusion: Spondylodiscitis should be considered for all patients presenting with chronic LBP with systemic symptoms and evidence inflammation. MRI is required to establish a diagnosis and evaluate the spread of infection. CT-PDB is useful to identify the causative micro-organism before antibiotic administration. These findings could to pave the way for constructing national guidelines. Keywords: Infectious spondylodiscitis, Low back pain, Epidemiology, Outcome, Tunisia