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Infectious Spondylodiscitis: A Retrospective Study of 140 Patients

Lebre, Ana MD*; Velez, Jorge MD; Rabadão, Eduardo MD*; Oliveira, Joaquim MD; da Cunha, José Saraiva MD, PhD; Silvestre, António Meliço MD, PhD

Infectious Diseases in Clinical Practice: July 2014 - Volume 22 - Issue 4 - p 223–228
doi: 10.1097/IPC.0000000000000118
Original Articles

Backgrounds: Spondylodiscitis (SD), which encompasses vertebral osteomyelitis, spondylitis, and discitis, is a pathology lacking consensus on optimal management.

Methods: 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.

Results: 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.

Conclusions: 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.

From the *Infectious Diseases Unit, Centro Hospitalar e Universit`rio de Coimbra, Coimbra, Portugal; and †Infectious Diseases Service of Hospital Infante D. Pedro, Aveiro, Portugal; ‡Infectious Diseases Unit, Centro Hospitalar e Universit`rio de Coimbra, Coimbra, Portugal.

Correspondence to: Ana Isabel Maia Fontes Lebre, MD, Infectious Diseases Department of University Hospital of Coimbra, Portugal. E-mail:

The authors have no conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.