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Arch Hellen Med, 30(5), September-October 2013, 595-605


Spontaneous bacterial spondylodiscitis: Diagnostic approach and evaluation of conservative management

D. Stoimenis, C. Spyridonidou, N. Papaioannou
First Department of Internal Medicine, "G. Papanikolaou" General Hospital of Thessaloniki, Thessaloniki, Greece

OBJECTIVE Evaluation of the clinical features, laboratory findings, management and outcome of patients with spontaneous bacterial spondylodiscitis.

METHOD Ten patients with spontaneous bacterial spondylodiscitis hospitalized over a 5-year period were studied. Demographic characteristics, underlying diseases, clinical signs and symptoms, imaging findings, isolated microorganisms, treatment and outcome were recorded.

RESULTS All 10 patients presented with gradually deteriorating back pain and fever (>37.8 °C) of 25−90 days duration. No common predisposing factor was recognized other than immunodeficiency and diabetes mellitus in some patients. Laboratory tests revealed in almost all cases normocytic anemia and increased levels of inflammatory markers. Blood culture was diagnostic in most patients; Staphylococcus aureus was the most frequent isolate. Biopsy of the spine was performed in 2 patients. MRI is considered the modality of choice for diagnosis of the lesions in the spine and detection of epidural or paravertebral expansion or psoas abscess. The most common sites of infection were the thoracic and lumbar spine. All patients were managed conservatively with parenteral, followed by oral, antibiotic therapy for a mean duration of 3 months. Nine patients regained normal ambulatory status; poor outcome was recorded in only one patient in whom the lesion was associated with neurological deficits.

CONCLUSIONS The diagnosis of pyogenic spinal infection should be considered in any patient with acute or subacute back pain and fever. Long-term monitoring is required to determine relapse of the disease.

Key words: Conservative management, Spontaneous bacterial spondylodiscitis, Staphylococcus aureus.

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