Evaluation of Pyogenic, Brucella and Tuberculous Spondylodiscitis Cases

Esma Kepenek Kurt, Bahar Kandemİr, İbrahİm Erayman, Mehmet Bİtİrgen

Necmettin Erbakan University, Meram Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey

Introduction: Spondylodiscitis (SD) is an infection of the intervertebral disk and adjacent vertebra. The objective of this study was to investigate clinical and laboratory characteristics and specific aspects of the cases divided into groups as tuberculous spondylodiscitis (TSD), pyogenic spondylodiscitis (PSD) and Brucella spondylodiscitis (BSD).

Methods: A total of 233 SD patients aged ≥ 18 years and followed-up in our Necmettin Erbakan University, Meram Medical Faculty between 2008 and 2019 were retrospectively evaluated. 

Results: Of the 233 patients included in the study 120 (51.5%) were female and 113 (48.5%) were male with a mean age of 62.12±14.3 years. PSD was found in 154 (66.1%), BSD in 50 (21.5%) and TSD in 26 (11.2%) patients. Mixed SD was detected in three patients. The most common admission complaint of the patients was back pain in 195 (84.8%) patients. The mean onset of complaints was found as 212 days respectively. A history of previous operation, recent infection, anemia, neutrophilic leukocytosis, thrombocytopenia and hypoalbuminemia were higher in PSD group. Uncontrolled diabetes mellitus was more common in TSD and PSD groups (p=0.04). Of BSD patients, 86% had previous brucellosis. Muscle spasm was observed in 15.5% and neurologic deficit in 39.1%. The most common involvement was found in the lumbar vertebra by 51.3%. Thoracic vertebra involvement was significantly higher in TSD group (p=0.023). Blood culture growth was found in 31 (13.3%) patients with the most commonly isolated microorganism being Coagulase negative staphylococci (CNS) in 12 (38.7%) patients. 

Conclusion: SD is often resulted from pyogenic bacteria and lumbar vertebrae are influenced. Since patients with SD may present with lower back pain, leg pain and other nonspecific findings, SD should be kept in mind in the differential analysis in patients presenting to other clinics with lower back pain. Brucellosis and tuberculosis should be considered in the differential diagnosis of SD.