LAUSR

Background Infectious spondylodiscitis is an infection involving the vertebral endplates and the intervertebral discs. The diagnosis is based on a combination of clinical symptoms, biological and radiological findings. Identifying the causative germ is sometimes difficult and a CT-guided discovertebral biopsy (DVB) might be of help, with varying success rates. Objectives The aim of this study was to assess the contribution of CT-guided DVB in the diagnosis of infectious spondylodiscitis in a rheumatological environment in Tunisia. Methods A retrospective study including patients diagnosed with infectious spondylodiscitis in the rheumatology department of Farhat Hached hospital, Sousse, Tunisia, between 1998 and 2017. Only patients who underwent a DVB for etiologic diagnosis of infectious spondylodiscitis were included in this study. Results Thrity five patients, with 12 (34.3%) women, were included. The mean age was 57.31±19.14 years [15–83 years]. All patients presented with back pain for 83.06±73.32 days [10–330 days], seven (20%) patients had fever and six (17.1%) patients had abnormal neurological signs on examination. The mean WBC, CRP and ESR levels were respectively 8170.83±3476.94 elements/mm3, 50.22±59.22 mg/L and 86.85±50.74 mmh1. The affected levels were the lumbar in 23 (65.7%) cases and dorsal spine in 9 (25.7%) cases. Three patients (8.6%) had both dorsal and lumbar spondylodiscitis. First DVB was contributive in 11 (31.4%) cases. Isolated germs were staphylococcus aureus in 4 (36.4%) cases, tuberculosis in 3 (27.3%) cases, and brucellosis, coagulase negative staphylococcus, enterobacter cloacae, streptococcus oralis in one case each. Only one patient underwent a second DVB attempt, which was contributive, isolating a staphylococcus aureus. The rest of patients were treated based on late bacteriological findings (2 cases of brucellosis, 2 cases associated with Escherichia coli urinary infection and 1 case with pulmonary tuberculosis), or presumption arguments (6 cases treated as pyogenic infection and 12 cases as tuberculosis). Conclusions DVB remains essential for the positive diagnosis of infectious spondylodiscitis. Nevertheless, its bacteriological insufficient contribution should not delay therapeutic management based on presumption arguments. Disclosure of Interest None declared