LAUSR

Infectious spondylodiscitis is a diagnosis and therapeutic emergency. Its clinical presentation can be insidious and standard radiographs can be falsely reassuring. This explains the interest of cross-sectional imaging and more particularly magnetic resonance imaging (MRI).To analyse the contribution of imaging in the diagnosis of infectious spondylodiscitis.These are 113 cases of spondylodiscitis collected in a rheumatology department over a period of 20 years [1998-2018]. The diagnosis is made on the basis of clinical, biological, radiological and bacteriological data.Our population was divided into 62 men (54.9%) and 51 women (45.1%) (p = 0.8) with an average age of 55 years [16–86]. Predisposing factors were found in 52.2% of cases: diabetes (23%), neoplasia (2.7%), hepathopathy (5.3%), long-term corticosteroid therapy (1.8), recent surgery (3.5%), history of tuberculosis (2.7%) and consumption of unpasteurized dairy products (28.3%).The approximate time between onset of symptoms and diagnosis ranged from 0.23 to 24 months (median 3 months). Impaired general condition was observed in 81% of the cases and fever in 34.5% of the cases. Radiculalgia was found in 46% of the cases and a neurological deficit was noted in 16% of the cases. Biological inflammatory syndrome was found in 91.2% of the cases.Standard radiographs of the spine were abnormal in 85% of cases, showing disc space narrowing (72%), irregularity of the vertebral plates (35.5%), erosions (13.1%) and para-vertebral spindle (4.7%). CT and spinal MRI were performed respectively in 57.5% and 70.8% of cases and revealed: erosions (46.2%), mirrored geodes (16.9%), para-vertebral abscess (57.5%), epiduritis (71.3%) and spinal compression (26.3%). The lumbar spine was the most affected (55.8%), followed by the dorsal spine (30.1%) and the cervical spine (8.8%). The Infectious spondylodiscitis was multifocal in 24.8% and multi-stage in 12.4% of cases.A disco-vertebral biopsy was performed in 70% of cases and was contributory in 44.3% of cases. The causative organism was tuberculosis in 55.8% of cases, brucellosis in 21.2% of cases and pyogenic germs in 23% of cases.Imaging plays an important role in the diagnosis of spondylodiscitis. MRI is considered the key examination, capable of mapping injuries and detecting potentially serious neurological complications. The importance of imaging the entire spine to detect multifocal forms should also be emphasized.None declared