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A retrospective study of Spondylodiscitis with clinical, imaging and therapeutic correlations

Barbara Brogna*, Alessandra Coppola, Elio Bignardi

Introduction: Diagnosing Spondylodiscitis (SD) can be challenging in clinical practice with highly variable outcomes. The aim of this study is to retrospectively analyze the clinical, laboratory, imaging findings of patients with SD treated at our hospital between January 2017 and December 2018. We also evaluated the SD evolution during a short follow-up at 4 and 6 weeks.

Methods: The epidemiological, clinical, microbiological, laboratory findings (White Blood Count (WBC), C-Reactive Protein (CRP) and Erythrocyte Sedimentation rate (ESR)), Imaging (CT/MRI) and treatment data of 38 patients with SD were studied retrospectively. The laboratory findings (CRP, ESR) and the CT/MRI examinations during the follow-ups at 4 and 6 weeks were evaluated. Based on imaging (CT/MRI) we divided SD into the following 5 types based on morphological features observed: spondylitis or discitis (ST/DS), SD, SD with paravertebral abscesses (SD-PA), SD with epidural abscess (SD-EP) and SD with paravertebral and epidural abscesses (SD-PEA).

Results: The most common complaint was pain (95%) and the main comorbidity was septicemia (42%). Staphylococcus aureus was found in 45% of the cases. The WBC was elevated in 32% of the patients. Both the CRP and ESR decreased during the follow-up. SD was found in 31% of the cases, SD-PA in 26% of the cases, ST/DS in 19% of the cases, SD-PEA in 13% of the cases and SD-EP in 11% of the cases. At the follow-up at week 4, SD-PA, SD-EP and SD-PEA had decreased and were found respectively in 21%, 5% and 5% of the cases. In the follow-up at week 6, SD-PA, SD-EP and SD-PEA were found respectively in 10%, 8% and 3% of the patients. Conservative treatment with antibiotic therapy was applied in 63% of the cases. Surgical treatment was given to 21% of the patients and an interventional procedure was done on 16% of the patients.

Conclusion: SD diagnosis and management continues to be based on a multidisciplinary approach. Re-imaging in the critical period of 4-6 weeks with the monitoring of systemic inflammatory markers can be a good follow-up strategy.