AB0912 Assesment of clinical and radiological prognostic variables in patients with spondylodiscitis

Abstract

Background: Spondylodiscitis is an infectious disease of the intervertebral space, often caused by hematological spreading from a distance septic focus, especially Endocarditis. Because of its low incidence combined with an ambiguous symptoms, delay diagnosis and treatment of this condition, raising probability of an undesirable outcome. Objectives: To identify poor prognosis variables in patients with Spondylodiscitis Methods: Observational retrospective study with non-quirurgic spondylodiscitis patients from 2010 to 2016 was performed. Demographic information, clinical history, laboratory test and radiological data were compiled from the clinical history management software. Statistical analysis was performed with the software R (version 3.3.2). Results: We included 55 patients, with a mean age of 63.47 (16.11) years old. Males predominated (69%). The average time with axial pain was 64.44 (80.63) days. Mean length of hospital stay was 64.44 (80.63) days and readmission rate was 32.7%. 20% of patients required further surgical procedures. Most of patients showed high CRP levels at their admission, with an average value of 112.97 (83.64) mg/L. Underlying endocarditis proportion was 16.4% and in this patients hospital stay was significative higher; nevertheless, it was not correlated with worse prognosis. 50% of patients showed vertebral destruction on MRI; 14.8% cord compression and 20.4% of patients developed neurological complications (7 of them paraparesis). Furthermore, vertebral destruction was statistically correlated with epidural abscess (P=0.026). Isolation and microbiological identification in blood cultures was possible in 83.6% of patients. Most frequent bacteria was Gram positive (50.09%), then Gram negative (18.2%), mycobacteria (10,9%) and fungi (3.6%). Conclusions: Delay in diagnosis is an important issue in Spondylodiscitis patients. Higher complications rates are mainly in relation to greater vertebral destruction. Underlying infectious endocarditis was described in a small proportion of patients in contrast to other studies. Presence of epidural abscess was also correlated with vertebral destruction, for this reason, patients with this finding should be more carefully follow-up.