Spondylodiscitis (SD), which encompasses vertebral osteomyelitis, spondylitis, and discitis, is a pathology lacking consensus on optimal management.
This was a retrospective analysis of medical records of all patients with diagnosis of SD admitted in an infectious diseases department, over a 24-year period (1988–2011). Demographic, clinical, etiologic, radiological, and therapeutic data were collected.
One hundred forty patients were enrolled, mostly male (63%), with mean age 57 years (range, 17–83 years), with average hospital stay of 46 days (range, 1–190 days). Most frequent complaints were pain (96%), fever (46%), and neurological impairment (26%). Average duration of symptoms was 4.5 months (range, 3 days to 48 months). Magnetic resonance imaging was the imaging technique more often performed, showing compatible abnormalities in 115 of 116 patients, with the lumbar vertebrae predominantly involved (55%). In 60% of cases, a definitive diagnosis was achieved (Brucella spp: 47; Staphylococcus aureus: 19; other bacteria: 11; Mycobacterium tuberculosis: 7; Candida albicans: 1). Etiology was presumed in 26% and undetermined in 14% of patients. Overall, the most prevalent was brucellar SD (39%), followed by tuberculous SD (24%) and pyogenic SD (23%). Most patients (96%) were managed medically, with regimens varying according to etiology and treatment response. Outcome was mostly favorable (82%), whereas 5% of patients died, and 10% were lost to follow-up. The remainder exhibited no clinical improvement.
Results confirmed that an older population is mainly affected, and nonspecific manifestations lead to significant diagnostic delay. Prolonged antibiotherapy and targeted surgery appear to improve long-term prognosis. In Portugal, like other Mediterranean countries, brucellosis and tuberculosis were frequently implicated.