Evaluation of clinical features and follow-up results of brucella spondylodiscitis cases

Introduction: Since there is no standard treatment regimen and duration in brucellosis spondylodiscitis cases, management of brucellosis spondylodiscitis cases is difficult. This study aimed to evaluate the risk factors, clinical features and follow-up results of brucellosis spondylodiscitis cases followed up in a tertiary healthcare institution. Methods: In this retrospective study, data from 60 patients with brucellosis spondylodiscitis who were followed up in a training and research hospital between 2009-2019 were evaluated from the electronic data recording system. All statistical analyses were performed using the SPSS 26 program. Comparison of the distributions of variables in the compared groups was made using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. Results: A total of 212 patients were followed up with a diagnosis of brucellosis. Spondylodiscitis was detected in 60 (28.30%) cases. In cases developing brucella spondylodiscitis, the duration of symptoms was longer (p=0.007), lower back pain (p=0.000), muscle pain (p=0.023) were more common and sedimentation values were higher (p=0.044). Three (5%) cases had single vertebra involvement, 34 (56.70%) cases had two vertebra involvement and 23 (38.30%) cases had ≥3 vertebra involvement. The most common involvement was in the lumbar region (23 cases, 38.30%), followed by the thoracic region (13 cases, 21.70%) and lumbosacral region (11 cases, 18.33%). Abscess was detected in 21 (35%) cases. Seventeen (28.30%) cases were given a treatment regimen containing two antibiotics and 43 (71.70%) cases were given a treatment regimen containing three antibiotics. Treatment regimens containing three antibiotics were found to be more successful (p=0.001). The mean treatment duration of the cases was 19.7±12 weeks (minimum 12-maximum 66 weeks). Relapse occurred in five (8.30%) cases. While muscle weakness and neurological deficits developed in three (5%) cases, two of them underwent surgery. Conclusion: Brucella spondylodiscitis is a not uncommon manifestation of the disease. In most cases, more than one vertebral involvement was affected. Treatment regimens containing three antibiotics were found to be more successful than regimens containing two antibiotics. Cases with muscle weakness and neurological deficits as complications were detected. A team consisting of infectious diseases, radiologists, neurosurgeons and physical therapy specialists may be useful for the treatment of spondylodiscitis.