Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study"
Tarih
2015Yazar
Erdem, HakanElaldi, Nazif
Batirel, Ayse
Aliyu, Sani
Sengoz, Gonul
Pehlivanoglu, Filiz
Ramosaco, Ergys
Gulsun, Serda
Tekin, Recep
Mete, Birgul
Balkan, Ilker Inanc
Sevgi, Dilek Yildiz
Giannitsioti, Efthymia
Fragou, Archontoula
Kaya, Selcuk
Cetin, Birsen
Oktenoglu, Tune
DoganCelik, Aygul
Karaca, Banu
Horasan, Elif Sahin
Ulug, Mehmet
Man, Asuman
Kaya, Safak
Arslanalp, Esra
Ates-Guler, Selma
Willke, Ayse
Senol, Sebnem
Inan, Dilara
Guclu, Ertugrul
Tuncer-Ertem, Gunay
Meric-Koc, Meliha
Tasbakan, Meitem
Senbayrak, Seniha
Cicek-Senturk, Gonul
Sirmatel, Fatma
Ocal, Gulfem
Kocagoz, Sesin
Kusoglu, Hulya
Guven, Turner
Baran, Ali Irfan
Dede, Behiye
Yilmaz-Karadag, Fatma
Kose, Sukran
Yilmaz, Hava
Asian, Gonul
Algallad, D. Ashraf
Cesur, Salih
El-Sokkary, Rehab
Bekiroglu, Nural
Vahaboglu, Haluk
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BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available. (C) 2015 Elsevier Inc. All rights reserved.
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SPINE JOURNALCilt
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