Epidemiologic and Demographic attributes of Primary Spondylodiscitis in a Middle Eastern population sample

• Published in: World neurosurgery Vol. 95; pp. 31 - 39
• Main Authors: Menon, K Venugopal, MBBS, MS Orth, MCh (Orth), MSc (Orth Engg), Moawad Sorour, Tamer Malak, MBChB, MSc (Orth), MRCS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Brucellosis - epidemiology; Child; Child, Preschool; Disc space infection; Discitis - epidemiology; Female; Humans; Infant; Infective spondylitis; Lumbar Vertebrae; Male; Middle Aged; Middle East - epidemiology; Neurosurgery; Prevalence; Pseudomonas aeruginosa; Pseudomonas Infections - epidemiology; Pyogenic infection; Retrospective Studies; Sex Distribution; Spondylodiscitis; Staphylococcal Infections - epidemiology; Staphylococcus aureus; Tuberculosis, Spinal - epidemiology; Vertebral osteomyelitis; Young Adult; CRP; Erythrocyte Sedimentation Rate; Acid Fast Bacillus; ESR; infective spondylitis; Tb; Tuberculosis; disc space infection; Pyogenic infection; Spondylodiscitis; Polymerase Chain Reaction; vertebral osteomyelitis; C Reactive Protein; AFB; PCR; Disc space infection; Vertebral osteomyelitis; Infective spondylitis; TB
• DOI: 10.1016/j.wneu.2016.07.088
• ISSN: 1878-8750

Abstract Background The prevalence and characteristics of spontaneous spondylodiscitis in the Middle East is unknown. There seems to be an emerging dominance of pyogenic infections over Tuberculosis and Brucellosis. Methods Retrospective observational study based on electronic case records of 4 years from a tertiary reference facility in Oman. Case records, microbiology reports, blood reports, imaging studies, histopathology and surgical reports of all spinal infection cases were studied. Secondary infections following invasive spinal interventions and expatriate patients were excluded. Risk factors and co-morbidities were also analysed. Results Sixty-two cases of primary spondylodiscitis of the spine were identified in this cohort including 10 Tb cases, 1 Brucella and 1 Tb with Pyogenic infection. Of the 50 pyogenic infections 4 were children; among the adults the mean age was 49.5 years with 63.8% males. Thirty-three patients had no medical co-morbidities. Common ailments associated were 18 Diabetes Mellitus, 13 hypertensives, 6 renal insufficiency, 2 liver Cirrhosis, 3 Alcoholism, 5 HCV and 2 immunosuppressions. Over 69% involvement was in the lumbar spine. Fourteen patients grew Staph. Aureus followed by 9 who grew Pseudomonas Aeroginosa while 35.4% were culture negative. Conclusions Spontaneous infective spondylodiscitis affects older men with and without medical co-morbidities equally. It often involves the lumbar spine and a third of patients are culture negative. Tuberculosis constitutes only about 17% of primary infections in the spine in this population sample.