AB1279 CLINICAL FEATURES AND FUNCTIONAL OUTCOME OF SURGICALLY TREATED TUBERCULOUS AND BRUCELLAR SPONDYLODISCITIS IN TUNISIA

Abstract

Background: Tuberculous and brucellar spondylodiscitis are still a frequent condition in the Mediterranean countries [1]. Management of spondylodiscitis may require surgical procedures in case of spinal cord or root compression, bone destructions and deformities, unsuccessful medical treatment or large abscesses. Objectives: To study characteristics and outcome of surgically treated tuberculous and brucellar spondylodiscitis. Methods: Medical records of patients who presented to the physical therapy and rehabilitation ward or outpatient clinics after spine surgery for spondylodiscitis were retrospectively studied. The study included records from January 2010 to December 2022. Results: Thirty-two patients were diagnosed with spondylodiscitis for which they underwent surgery. Mean age of diagnosis was 44,6 ± 10.4 years. The sex ratio was 1:1. Atypical presentations caused diagnosis to be delayed in 37,5% of the patients. Back pain was the most frequent symptom seen in 78,12% of the cases, radicular pain was seen in 46,7% of the cases, fever in 37,5% of the patients and abnormal gait in 68,7% of the cases. Tuberculosis caused 71,8% of cases and brucellar infection 28,1% of the cases. On biology, elevated inflammatory markers were noted in 68,7% of the cases. Intradermal reaction for tuberculosis was positive in 11 patients while cultures allowed the diagnosis of tuberculosis in 1 patient. Wright serology test confirmed the diagnosis of brucellar infection in all 9 cases. Vertebral biopsy or intraoperative samples allowed the diagnosis of the tuberculous spondylodiscitis in the remaining cases. Cervical spine location was involved in 9,3% of cases, lumbar spine in 43,75% and dorsal spine in 34,3% of the cases. All patients have been prescribed antibiotics and spinal immobilization. Surgery was indicated in 71.8% of cases for spinal cord decompression and in 28.1% of the cases for voluminous abcesses. Anterior approach was used in 9,3% of the cases and posterior approach in 90.6% of cases. 37.5% of the patients benifited concomitantly with spinal fusion surgery. Post-operative complications were reported in 43,75% of the cases. They consisted in spinal instability in 71,4% of the cases, abcesses in 14,28% of the cases and the emergence of secondary articular localizations in 28,57% of the cases. 25% of the patients underwent a second surgery mainly to stabalize the spine. Before surgery, walking was impossible for 68,7 % of the patients and 12 months after surgery only 37,5% of the patients couldn't walk. Conclusion: Spinal surgery in tuberculous or brucellar spondylitis are indicated if medical treatment is insufficient and especially in the occurrence of neurological complications. Surgery may be invasive with various complications but sometimes it could be the only option to treat a neurological deficit.