Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital.
OBJECTIVE
The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included.


METHODS
We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/- 16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI).


RESULTS
In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %).


CONCLUSIONS
Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.
Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, Madrid, Spain. jcebrian.hcsc@salud.madrid.org
Juan Luis
JL
Cebrián Parra
Alvaro
A
Saez-Arenillas Martín
Antonio L
AL
Urda Martínez-Aedo
Isabel
I
Soler Ivañez
Emilio
E
Agreda
Luis
L
Lopez-Duran Stern
D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000382:microbiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D015299:Discitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000382:microbiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000382:microbiology*; D016896:Treatment Outcome