Retrospective evaluation of patients diagnosed with infective spondylopathy

Aim: Spondylodiscitis is an infectious disease that can involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal. Diagnosis is a challenging process for clinicians due to the fact that its symptoms are nonspecific and often have an insidious onset. The fact that the agent cannot be identified in one third of the patients is one of the important factors that makes the management of these patients difficult. Prolonging the time between the first symptoms and diagnosis can lead to serious problems in patients, especially neurological complications. For accurate diagnosis and effective treatment, clinical and diagnostic features must be defined in patients. The aim of this study is to determine the clinical and diagnostic features as well as the factor distribution in spondylodiscitis patients, to emphasize patient follow-up and treatment features, and to develop a common approach in the management of this disease, which has a high rate of re-admission after treatment. Materials and method: In our study, patients with radiological findings compatible with spondylodiscitis, complaints of pain, and laboratory signs of infection were diagnosed with spondylodiscitis, and all patients who were hospitalized and followed up at Karadeniz Technical University Farabi Hospital Infectious Diseases and Clinical Microbiology Clinic between January 1, 2012 and December 31, 2022 were evaluated retrospectively. Results: 202 spondylodiscitis patients were included in the study. 107 of these patients were men (%52.9) and 95 (%47) were women. The average age of the patients was calculated as 60.6±13.5 years. The lowest age was 17 and the highest was 94. 7(%33.1) of the patients were followed up with the diagnosis of pyogenic spondylodiscitis, 13 (%0.06) were tuberculous spondylodiscitis, 48 (%23.7) were followed up with the diagnosis of brucella spondylodiscitis, and 74 (%36.6) were patients whose causative agent could not be isolated. 119 of the patients (%58.9) were accompanied by at least one additional disease. When the accompanying comorbidities were compared according to groups, it was determined that the frequency of DM in pyogenic spondylodiscitis increased 2.6 times compared to other groups (p = 0.003), and the rate of hypertension in the pyogenic spondylodiscitis group increased 2.6 times (p = 0.002). When the patients' complaints are examined; Pain was the accompanying symptom in all groups, and 93 (%46) had fever, 78 (%38.6) had night sweats, and 51 (%25.2) had weight loss. The rate of night sweating accompanying Brucella spondylodiscitis was found to be 3.3 times higher than the other groups (p=0.0005). Neurological deficit was identified in 55 (%27.2) patients, and the incidence rate in the pyogenic spondylodiscitis group was significantly higher than in the group in which the agent was not isolated (p = 0.012). It was determined that the onset of the patients' complaints was an average of 77.4 days (min = 7, max = 700) before the application date. This period was significantly higher in the tuberculosis group compared to the pyogenic (p < 0.001) and brucellosis (p < 0.001) groups, and there was no significant difference between the group in which the agent was not isolated. A history of previous spinal surgery was detected in 74 of the patients (%36.6). It was found that the risk of developing pyogenic spondylodiscitis increased 2-fold in patients with a history of spinal surgery (p = 0.025, OR = 1.2). 16 (%7) of the patients with a history of spinal surgery had instrumentation (such as screws, plates, etc.). In the presence of instrumentation, the incidence of pyogenic spondylodiscitis was found to increase 7.2 times (p = 0.002). MRI findings of the patients were evaluated, and all patients had multi-level vertebral involvement, and the first frequency was lumbar involvement in %51.9, and the second frequency (%24.7) was thoracic region involvement. 128 (%63.3) of the patients were accompanied by abscess. The most common association was seen in the pyogenic spondylodiscitis group, but there was no significant difference between the groups. At the beginning of treatment; CRP was significantly higher in the pyogenic spondylodiscitis group than in the other groups (p<0.001), and ESR was significantly higher in the pyogenic group compared to the brucellosis and tuberculosis groups (p<0.001). While CRP levels at the end of treatment were significantly higher in the pyogenic group than in the brucellosis group (p = 0.007), ESR levels were significantly higher in the pyogenic group than in the tuberculosis and brucellosis groups (p < 0.001). Biopsy was performed in 104 of the patients (%51.4). Growth was detected in 52 (%50) of 104 patients whose biopsy cultures were sent. The most frequently isolated organism was Staphylococcus aureus (%40.7). Methicillin resistance was %15.4. Histopathological examination was performed on 73 (%36.1) of the biopsied patients, and inflammatory findings were detected in 53 (%72.6) of the results. A significant difference was detected in biopsy culture positivity rates between patients with and without inflammatory findings (p = 0.047). Percutaneous biopsy was performed on patients who were followed up with a diagnosis of tuberculosis, and tuberculosis culture growth was detected in %69.2 of the patients, and necrosis and granulation tissue compatible with tuberculosis was detected in %27.2 of the patients. %50 of patients with a previous history of tuberculosis were diagnosed with tuberculous spondylodiscitis. No difference was detected between the treatment failure rates of IV and oral antibiotherapy regimens in empirical treatments started in patients in whom the causative agent could not be isolated and in treatments started against pyogenic factors (p=0.894, p=0.365). After their treatment was completed, %34.6 of the patients applied again. The complaints of %52.8 of these patients were considered to be due to non-infectious causes or as a complication of spondylodiscitis, and %47.1 were considered as treatment failure. When the laboratory values of patients whose treatments were successful and those whose treatments were considered unsuccessful were compared; It was found that CRP and WBC values decreased significantly in both groups in the 1st month of treatment (p<0.0001), while ESH values decreased in the 1st month in the successful group, they remained relatively high in patients who were considered treatment failures (p=0.179). Conclusion: This study emphasizes the importance of accurate diagnosis and effective treatment and clinical and laboratory monitoring of post-treatment complications in patients with spondylodiscitis. As a result of detailed examinations and comparisons, it was pointed out that the agent profile may vary depending on different conditions that may accompany it. Meticulous monitoring of laboratory parameters, especially ESH monitoring, is important in predicting treatment failure. Additionally, as our study shows, there is no significant difference in terms of treatment failure of IV and oral options between treatments started empirically in the group where the agent could not be isolated and treatments started for the agent in the pyogenic group. These findings can be taken into account in patients' treatment selection. It emphasizes the need for careful monitoring of patients, complications that may arise during and after the treatment, and regular follow-up of treatment responses in terms of clinical and laboratory parameters.