Spontaneous spondylodiscitis: a retrospective, single-center series
EANS Academy. Ortega-Angulo C. 09/25/19; 275556; EP02115
Celia Ortega-Angulo
Celia Ortega-Angulo

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Objectives: Spontaneous spondylodiscitis (SS) is an uncommon but potentially serious condition of the spinal column. Risk factors include diabetes, immunosuppression and the use of intravenous drugs. Our series describes retrospectively the incidence, treatment, and results of this entity in 26 consecutively diagnosed patients.
Methods: A retrospective study of 26 patients with SS treated in our center from January 2014 to December 2018 is described. All patients were evaluated by a clinician and a neurosurgeon and had a complete clinical evaluation, laboratory workup and follow-up as outpatients.
Results: The median age was 64.7 years old, with 23% patients above 80 years old. 53.8% presented a distant infection (55.5% of them suffered from endocarditis). The initial symptom was pain in 42.3%, fever in 19.2% and both in 30.8%. The median interval from the beginning of symptoms to diagnosis was 2.6 weeks. Only 2% of patients presented with neurological deficit. In 69.2% of cases the infection was pyogenous and in 7.7% was granulomatose in origin. In 23.1% we couldn't identify the organism. S. Aureus was isolated in 23.1%, gram-negative bacilli in 19.2%, anaerobes in 11.5% and Mycobacterium tuberculosis complex in 7.7%. A major part of patients (46.2%) were treated with an orthosis and 23.1% were operated. The median duration of intravenous and oral antibiotic therapy was 3.3 and 5.7 weeks respectively. 42.3% of patients suffered some kind of complication; 69% presented symptomatically improve at discharge and mortality was 7.7% in our series.
Conclusions: For the major part, SS is a clinical condition that requires prolonged treatment with intravenous and oral antibiotics. In cases with neurological deficit, failure to respond to medical treatment, abscess formation, bone destruction and/or spinal instability, surgical treatment should be considered.
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