Increasing incidence of pyogenic spondylodiscitis: A 14-year population-based study
Introduction
Pyogenic spondylodiscitis remains a diagnostic challenge, and affected patients are at risk of permanent neurological deficits and chronic pain.1, 2, 3 Newer data suggest that treatment with antibiotics for a period of 6 weeks are as effective as treatment for 12 weeks; but the general recommendation has until recently been towards the need of long-term treatment.4, 5
The incidence rate of non-tuberculosis non-postoperative spondylodiscitis has previously been estimated to 2.2–2.4 cases per 100 000 person years,6, 7 and it has been reported to be increasing mainly due to an increase in culture negative cases8 and due to the increasing elderly population.9 The influence of age was highlighted in a study from 2009, where Hutchinson et al. found an incidence rate of 9.8 cases per 100 000 person years for the population over 65 years of age.10
The diagnosis is based on symptoms, clinical findings, and imaging and laboratory results. Nowadays, MRI is the main radiological examination and considered to be the gold standard imaging method.11, 12 Before MRI became widely available plain x-ray as well as leucocyte- and bone scintigraphy were used as diagnostic methods.13
The time from onset of symptoms to diagnosis is often long14, 15 probably due to lack of awareness and the often non-specific nature of symptoms.3, 16, 17
Most publications concerning spondylodiscitis are small with less than one-hundred cases. We report data from a larger population-based study describing changes in incidence rates as well as patient characteristics and clinical findings of pyogenic spondylodiscitis over 14 years.
Section snippets
Case identification and study population
We conducted a population-based study using the Funen County Patient Administrative System (FPAS) to identify all patients discharged with a diagnosis of spinal infection (including diagnosis of epidural abscesses, vertebral osteomyelitis, and discitis) during January 1994–May 2009 in Funen County, Denmark (population of 483 123 June 1, 200818). We identified patients with relevant discharge codes using the International Disease Classification coding system 10th edition (ICD-10) (A02.2; A18;
Results
We identified 1386 potential cases of pyogenic spondylodiscitis based on relevant discharge codes, and 192 of these met our case definition criteria and were included in the study (see Fig. 1).
The median age was 66.6 years (IQR: 56.2–75.6), 57.3% (110/192) were men.
Discussion
In this population-based study describing the characteristics of adult patients with pyogenic non-tuberculosis spondylodiscitis, we found that the overall incidence rate increased considerably during 1995–2008 and that the disease was the most common among the elderly with a higher incidence among men. This sex difference is in agreement with findings from other previous studies.9, 23 The reason for the higher incidence among men is not known with certainty, but it may be of importance that men
Acknowledgments
This work was supported by the Else Poulsen Mindelegat, the Region of Southern Denmark Research Grant and the University of Southern Denmark Research Grant.
References (34)
- et al.
Diagnosis, management and outcome of clinically- suspected spinal infection
J Infect
(2009) - et al.
Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis
SeminArthritis Rheum
(2011) - et al.
Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990
J Infect
(1997) - et al.
Spontaneous pyogenic vertebral osteomyelitis in nondrug users
Semin Arthritis Rheum
(2002) - et al.
Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals
Clin Infect Dis
(2002) - et al.
Vertebral osteomyelitis: long-term disability assessment and prognostic factors
J Infect
(2007) Clinical practice. Vertebral osteomyelitis
N Engl J Med
(2010)- et al.
Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95
ScandJ InfectDis
(2001) - et al.
Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003
Epidemiol Infect
(2008)
Spontaneous spinal infections in older people
Intern Med J
Spondylodiscitis: update on diagnosis and management
J Antimicrob Chemother
Clinical practice. Vertebral osteomyelitis
N Engl J Med
Vertebral osteomyelitis: assessment using MR
Radiology
Spinal osteomyelitis: a review of 10 years' experience
Orthopedics
Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases
Ann Rheum Dis
The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital
BMCInfectDis
Cited by (204)
Dual-Energy Computed Tomography and Beyond: Musculoskeletal System
2023, Radiologic Clinics of North AmericaPyogenic spondylitis of the upper cervical spine with basilar invagination: A case report
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults
2023, Infectious Diseases Now