TITLE:
Management of Spontaneous Spinal Discitis and Spondylodiscitis in Older People
AUTHORS:
Mohamed Adel Ghoneim, Waleed Abbass
KEYWORDS:
Spondylodiscitis, Diabetes Mellitus, Tuberculosis
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.10 No.1,
January
21,
2020
ABSTRACT: Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.