Pattern and Clinical Presentation of Spondylodiscitis at Kenyatta National Hospital

Abstract

Background: Spondylodiscitis is rare, often diagnosed late and can present with devastating complications. Spondylodiscitis accounts for 2%–4% of all cases of bone infection. To date there is limited local data that describes the patterns and clinical presentation of spondylodiscitis. Study Objective: To determine the pattern and clinical presentation of patients with spondylodiscitis at Kenyatta National hospital. Study Duration: November 2018 to January 2019 Study population: Patients diagnosed with spondylodiscitis at Kenyatta National hospital. Study Design: Cross-sectional study. Methodology: Forty-two patients with MRI diagnosis of spondylodiscitis were recruited in this study. Information on presenting symptoms, examination findings and radiological features (number and level of vertebrae involved and presence or absence of abscesses) were collected. Data Processing: The collected data was coded and analysed using the SPSS v. 25 for windows. Data was analysed for frequencies, means and variances. A student T test was used to compare means in different gender and age groups. Results: The age of the participants ranged from 16 to 72 years with a mean age of 39.7±13.4 years. The male female ratio of the participants was 2: 1. Risk factors for spondylodiscitis included smoking, HIV infection, positive history of PTB and DM in 45.2% (n=19), 17% (n = x 7), 11.9% (n=5) and 4.8% (n=2) respectively. Most patients presented with back pain, localized around the thoraco-lumbar (28.6%), lumbar (26.2%) and thoracic (50%) spine. The mean duration of the pain was 5.7±2 months. Most (97.6%) of the patients presented with limb weakness, and a sensory level in 76.2%. Eight patients (19%) had open biopsies with subsequent histology. In these eight patients, 5 were cultured and stained positive for mycobacterium tuberculosis. Using the MRI, the lesion was located in the cervical, thoracic, thoracolumbar and lumbar spine in 4, 21, 9 and 8 of the participants respectively. None of the patients presented with skip lesions. Most (n=36) of the patients presented with a single level lesion. Six patients presented with multilevel contiguous lesions. Nine patients had features of scoliosis (Cobbs angle >100). Seven participants had lumbar while two had thoracic spine scoliosis. Conclusions: In this setting, spondylodiscitis is diagnosed late, with significant neurological deficits, predominantly affects males, and is localised in the thoracic region. Smoking is an important risk factor. Recommendations: A high index of suspicion is recommended for all middle-aged patients with isolated back pain, with additional risk factors such as smoking, diabetes mellitus, pulmonary TB or HIV.