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Updated: Dec 22, 2025
Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Spondylodiscitis: A Retrospective Analysis of Clinical, Etiological, and Radiological Diagnosis
Afonso Cardoso1, Luís Barbosa1, Ana Marta Coelho1
1Hospital Beatriz Ângelo, Loures, Portugal.
Background:
Spondylodiscitis is an uncommon disease, and due to its indolent nature, it is often a late diagnosis. Great stress is put on the etiologic diagnosis, but blood cultures do not always yield positive results. Magnetic resonance imaging (MRI), despite being the diagnostic method of choice, is not always available. Our aim was to characterize the clinical presentation and to identify and check the efficacy of the etiologic and radiological methods of diagnosis of spondylodiscitis used at our hospital.
Methods:
A retrospective study was conducted in which spontaneous spondylodiscitis cases were identified. The clinical presentation and the results of etiologic and radiological methods of diagnosis were analyzed.
Results:
Over a period of 5 years, 34 patients fulfilled the inclusion criteria of the study. Regarding days of complaints, we identified a median of 9.5 days (1-547 days), with back pain being the predominant symptom. Fever was present in half the patients. Blood cultures were positive in 16 patients (48.5%). Nineteen patients underwent a computed tomography (CT)-guided biopsy (positive in 7 patients [36.8%]), and 10 patients underwent a surgical biopsy (positive in half of them). Overall, 27 patients (79.4%) had an etiologic diagnosis. The diagnostic work-up consisted mostly of an initial CT scan followed by a confirmatory MRI. Of note, in 5 patients the CT scan did not reveal changes that were later confirmed by MRI. A total of 29 patients (85.3%) underwent an MRI, with 28 being diagnostic.
Conclusions:
Spondylodiscitis remain a difficult diagnosis. Blood cultures should always be obtained before antibiotic administration and a CT-guided or surgical biopsy should be done if needed. Our results confirm the importance of MRI as the imaging modality of choice and highlight the possibility of false-negative CT scans and the inability of CT to allow for a definitive diagnosis.
Insights
Diagnosing spondylodiscitis is challenging. This study highlights the importance of Magnetic Resonance Imaging (MRI) and biopsies for accurate etiologic diagnosis when initial tests are inconclusive.
Area of Science:
- Medical diagnostics
- Infectious diseases
- Radiology
Background:
- Spondylodiscitis is an uncommon, indolent infection often diagnosed late.
- Etiologic diagnosis is crucial but blood cultures are frequently negative.
- Magnetic Resonance Imaging (MRI) is the preferred diagnostic modality but not always accessible.
Purpose of the Study:
- To characterize the clinical presentation of spondylodiscitis.
- To evaluate the efficacy of diagnostic methods used at our institution.
- To identify key diagnostic challenges and successful strategies.
Main Methods:
- Retrospective analysis of spontaneous spondylodiscitis cases over five years.
- Review of clinical presentations, etiologic investigations, and radiological findings.
- Comparison of diagnostic yield from blood cultures, CT-guided biopsies, and surgical biopsies.
Main Results:
- 34 patients were included; back pain was the predominant symptom, with a median complaint duration of 9.5 days.
- Blood cultures were positive in 48.5% of cases. Biopsies (CT-guided or surgical) yielded a diagnosis in 36.8% to 50% of patients.
- MRI was diagnostic in 28 out of 29 patients, confirming its utility, while CT scans showed false negatives in some cases.
Conclusions:
- Spondylodiscitis diagnosis remains challenging, necessitating a multi-modal approach.
- Blood cultures are recommended before antibiotics; biopsies are vital when initial results are negative.
- MRI is confirmed as the imaging modality of choice, with CT scans potentially yielding false negatives.
