Diagnostic delays in infective discitis - an unresolved problem

Area of Science:

• Neurology
• Infectious Diseases
• Spinal Cord Injury

Background:

• Spinal infections can cause neurological deficits in one-third of cases, often with non-specific symptoms leading to diagnostic delays.
• Timely diagnosis and intervention are critical for managing spinal infection and preventing severe outcomes like spinal cord impairment.

Purpose of the Study:

• To review the outcomes and timeliness of diagnosis in patients with spinal infection who experienced subsequent spinal cord impairment.
• To identify factors contributing to diagnostic delays and neurological deterioration in spinal infection patients.

Main Methods:

• A retrospective study of 40 patients admitted for rehabilitation due to spinal cord impairment secondary to spinal infection.
• Data collected included patient demographics, infection source, diagnostic intervals, neurological status changes, and rehabilitation outcomes.

Main Results:

• Patients experienced long intervals to diagnosis and MRI (0-30 days), with 50% seeking prior medical attention.
• 37.5% deteriorated neurologically post-admission, some while on antibiotics. 17.5% sustained complete spinal cord impairment.
• The majority (67.5%) were discharged as wheelchair users, indicating significant long-term disability.

Conclusions:

• Delays in diagnosing spinal infections frequently occur pre-hospital, possibly due to a low index of suspicion in the community.
• Neurological deterioration can occur despite antibiotic treatment, highlighting the need for close monitoring.
• Early use of inflammatory markers and a low threshold for investigation are recommended for suspected spinal infections.