Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center
- Author:
Naveen PANDITA
1
;
Souvik PAUL
;
Gagandeep YADAV
;
Roop Bhushan KALIA
;
Pankaj KANDWAL
Author Information
- Publication Type:Original Article
- Keywords: Discitis; Low back pain; Staphylococcus aureus; Alkaline phosphatase; Lumbar vertebrae; Staphylococcal infections
- MeSH: 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
- From:Asian Spine Journal 2019;13(4):621-629
- CountryRepublic of Korea
- Language:English
- 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.
