Asian Spine J.  2019 Aug;13(4):621-629. 10.31616/asj.2018.0220.

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Affiliations
  • 1Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India. pankajkandwal27@gmail.com

Abstract

STUDY DESIGN: Prospective clinical study. PURPOSE: We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. OVERVIEW OF LITERATURE: Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis.
METHODS
Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis.
RESULTS
Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated.
CONCLUSIONS
Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum C-reactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

Keyword

Discitis; Low back pain; Staphylococcus aureus; Alkaline phosphatase; Lumbar vertebrae; Staphylococcal infections

MeSH Terms

Alkaline Phosphatase
C-Reactive Protein
Causality
Clinical Study
Comorbidity
Diagnosis*
Discitis*
Follow-Up Studies
Humans
Low Back Pain
Lumbar Vertebrae
Phosphoric Monoester Hydrolases
Prospective Studies
Spine
Staphylococcal Infections
Staphylococcus aureus
Tertiary Care Centers*
Tertiary Healthcare*
Visual Analog Scale
Alkaline Phosphatase
C-Reactive Protein
Phosphoric Monoester Hydrolases
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