Spondylodiscitis in a tuberculosis-endemic setting in Somalia: epidemiological, clinical, radiological, and outcome...

Spondylodiscitis is an important cause of spinal morbidity in tuberculosis (TB)-endemic settings, where limited microbiological capacity may complicate differentiation of tuberculous from non-tuberculous disease. Data describing the clinical spectrum and outcomes of spondylodiscitis in Somalia are limited.

To describe the demographic, clinical, radiological, microbiological, treatment, and outcome characteristics of patients with spondylodiscitis and to explore factors associated with clinical outcome.

We conducted a retrospective observational study of 121 eligible patients diagnosed with spinal infection at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital between 1 August 2023 and 31 July 2024. Demographic, clinical, radiological, microbiological, treatment, and outcome data were extracted from routine records. Associations were assessed using chi-square or Fisher's exact tests for categorical variables and Mann-Whitney U or independent-samples t-tests as appropriate for continuous variables. Outcome comparisons were restricted to patients with documented follow-up; multivariable logistic regression was not retained because only 19 unfavorable outcomes were available and outcome ascertainment was incomplete.

The mean age was 48.8 ± 18.1 years and 53.7% were male. Back pain (92.6%) and radicular pain (82.6%) were the most frequent presenting symptoms. Neurological deficit was documented in 46.3% and spinal deformity in 38.0%. Lumbar involvement was most common (48.8%), followed by thoracic involvement (25.6%); anterior-column involvement occurred in 97.5%. Epidural abscess was identified in 69.4% and is reported here as a radiological finding. Microbiological or histopathological testing was performed in 46 patients; 30 were TB-positive, corresponding to 65.2% positivity among tested patients and 24.8% confirmed TB among the total cohort. Eighty-five patients (70.2%) received empirical anti-TB treatment. Among 65 patients with documented follow-up, 46 (70.8%) achieved favorable outcomes. In bivariate analysis, TB exposure history was associated with outcome (p = 0.003), whereas operative/procedural intervention was not significantly associated with outcome (Fisher's exact p = 0.399).

Spondylodiscitis in this Somali tertiary-care cohort showed a substantial burden of neurological and radiological complications and a high proportion of empiric TB treatment. Because microbiological confirmation was limited and follow-up was incomplete, the observed confirmed TB proportion and favorable-outcome estimate should not be interpreted as population-level estimates. Prospective multicenter studies with systematic microbiological testing and complete follow-up are needed to clarify the etiological spectrum and prognostic factors.