A COMPARATIVE ANALYSIS OF RADIOLOGICAL FINDING BETWEEN TUBERCULOUS, BRUCELLAR AND PYOGENIC SPONDYLODISCITIS

BackgroundInfection spondylodiscitis (IS) is a serious infectious disease which involves intervertebral disc and its adjacent vertebral bodies but later may also extend into the the adjacent neural structures. The clinical picture of IS is rather non specific but there are significant radiological differences that permit a presumptive aetiological diagnosis and orient the initial empirical treatment.ObjectivesThis study aimed to compare the radiological features of of tuberculous (TS), brucellar (BS) and pyogenic spondylodiscitis (PS).MethodsA retrospective monocentric study involving 70 cases of infectious spondylodiscitis admitted between January 2009 and August 2019 at our rheumatology department. Clinical, laboratory and radiological data of the patients were collected.ResultsOf these 70 patients, 18 (25.7%) had TS, 8 (11.4%) BS and 44(62.9%) PS. There were 37 women (52.9%) and 33 men (47.1%). The age of the patients ranged from 12 to 82 years, with a mean of (SD±) 54± 15,23 years. Standard X-rays showed abnormalities suggestive of spondylodiscitis in 78.6% of cases. A great majority of the patients had involvement at only one vertebrae level (70%). The most frequently affected level, were the thoracic (33.3%), the lombosacral (100%) and the lombar (38.6%) segment in the TS, BS and PS respectively. In BS the lombosacral segment was significantly the most frequently affected level (p<0.0037). Computed tomography was performed in 52.9% of cases and showed that the epidural and paravertebral abscess were characteristic of tuberculous involvement (p=0.013 and 0.05). Magnetic resonnance imaging was performed in 63% of cases. The intervertebral disc narrowing was observed in 87.3% of patients. Paravertebral or epidural masses were present respectively in 53.5% and 86.7% of TS, versus 14.3% and 71.4% of BS, and 46.3% and 80.5% of PS, there were no significant differences between the groups.The enhancement was rather heterogeneous in the SDT and homogeneous in the two other groups, but these differences were not statistically significant.ConclusionThere are significant radiological differences between TS, BS and PS. A better understanding of typical and atypical manifestations on imaging can be an excellent diagnostic tool for every attending physician.Disclosure of InterestsNone declared