Title : A comparative study of tuberculous and pyogenic spondylodiscitis
Abstract:
Introduction:
Infectious spondylodiscitis, despite its rarity, represents a serious condition, mainly due to the risk of neurological complications. Rapid identification of the pathogen is essential for effective treatment, but in the absence of a microbiological diagnosis, a combination of clinical and radiological clues can guide treatment. The aim of this study was to compare the epidemiological, clinical, paraclinical and evolutive aspects of tuberculous spondylodiscitis (TS) and pyogenic spondylodiscitis (PS), in order to better understand their distinctive features.
Patients and methods:
This is a retrospective study conducted in a rheumatology department, including patients hospitalized for TS or PS between 2008 and 2023. Diagnostic criteria were based on microbiological analyses, clinical and radiological data.
Results:
A total of 71 cases were analyzed, with 35 cases of TS (49,3%) and 36 cases of PS (50,7%). The mean age was 57.57 ± 16.85 years for TS and 62.11 ± 14.61 years for PS. Women were more frequently affected by TS (62.9% vs 36.1% in PS, p =0.02 ). A history of diabetes was more common in the PS group (36% vs 8.6% in TS, p=0.05 ).
Clinical signs observed more often in the ST group compared to the SP group included night sweats (42.9% vs 16.2%, p = 0.02) and altered general condition (60% vs 17.2%, p = 0.05). On the other hand, both groups showed similar rates of high fever with no significant differences (51.4% vs 33.3%, p=0.1).
Regarding the location of infection, dorsal involvement was significantly more common in TS (36.7% vs 11.2% in PS, p =0.03), while lumbar involvement was more frequently seen in PS (86.1% vs 51.4%, p =0.04). Neurological complications were more common in ST including sensory deficit (p = 0.03), radiculalgia (p = 0.02), and spinal cord compression (p = 0.02). There were no significant differences between the two groups concerning the presence of paravertebr abscesses (36,1% for TS vs 31,1% for PS, p = 0.2).
The overall outcome was favorable in both groups, with 85.3% of ST patients and 81% of SP patients showing improvement, with no significant difference (p =0.1).
Conclusion:
Tuberculous and pyogenic spondylodiscitis, despite their clinical similarities, are different in several aspects, notably in terms of risk factors, symptoms and complications. Early and accurate diagnosis is essential for appropriate management and to avoid inappropriate treatment. Disco-vertebral biopsy remains the key to confirming the etiology, thus helping to personalize treatment and optimize clinical evolution.
