Spine infections: 14 years of experience in Trieste

What is it about?

Infectious spondylodiscitis is an infection of the vertebrae and intervertebral discs. It is uncommon but serious, and often diagnosed late because its main symptom, back pain, is so common. We reviewed 98 patients treated at the Trieste hospital between 2010 and 2023. The infection affected about 3 people per 100,000 each year. Just over half were caused by common bacteria, 10% by tuberculosis and in one third no germ was found. Staphylococcus aureus was the leading cause. Blood cultures identified the germ in about half of bacterial cases, and PET/CT scans were more useful than white-cell scintigraphy. Open surgical biopsy found the cause more often than CT-guided needle biopsy. Infections of the neck and chest spine had worse outcomes than lumbar ones. Complications included nerve damage, abscesses and endocarditis, and 6% of patients died of the infection.

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Photo by CHUTTERSNAP on Unsplash

Photo by CHUTTERSNAP on Unsplash

Why is it important?

These real-world data help clinicians recognize and diagnose spondylodiscitis more effectively: always take blood cultures, consider PET/CT when MRI is unclear, and prefer biopsy techniques with higher diagnostic yield. They also highlight that one third of patients need empirical treatment without a known cause, and that cervical and thoracic involvement deserve particular attention.

Perspectives