Background:Infectious spondylodiscitis is a therapeutic emergency and is a current problem. It can affect the different levels of the spine. Multifocal forms, touching several floors, however remain rare.Objectives:To compare the clinical, biological, radiological and therapeutic aspects of unifocal versus multifocal spondylodiscitis.Methods:This is a retrospective study of 113 patients admitted to our service over a period of 20 years [1998-2018]. The diagnosis of spondylodiscitis was made on the basis of clinical, biological, radiological and bacteriological data. We have divided our population into two groups: unifocal and multifocal spondylodiscitis.Results:Spondylodiscitis was more frequently unifocal (75.2%) than multifocal (24.8%). The average age of the patients was 55.8 years. There were 62 men and 51 women. There was no difference in age and sex between the two groups (p=0.5 and p=0.8, respectively).Diabetes was more frequent in the group of multifocal spondylodiscitis but with no statistically significant difference (p=0.4). No statistically significant difference between the two groups regarding the start mode (p=0.7), the schedule (p=0.3), the presence of neurological signs (p=0.7), fever (p = 0.2), impaired general condition (p=0.6) and biological inflammatory syndrome (p=0.6).Cervical and dorsal spine involvement was more common in multifocal spondylodiscitis (p = 0.02 and p = 0.01; respectively). There were 11 spondylodiscitis involving 2 floors (cervical and dorsal: 2 cases, cervical and lumbar: 3 cases, dorsal and lumbar: 6 cases) and 3 spondylodiscitis involving 3 floors.Radiologically, the presence of vertebral fracture and involvement of the posterior arch was more frequent during the multifocal form (p=0.03 and p=0.001; respectively). The frequency of para-vertebral abscesses, epiduritis and the presence of spinal cord compression were similar in the two groups (p=0.6; p=0.7 and p=0.2, respectively).Tuberculosis was more frequent during the multifocal form (p = 0.05) and brucellosis during the unifocal form (p = 0.03). Disco-vertebral biopsy was performed in 79 cases. It was more often contributory during multifocal spondylodiscitis (p = 0.03).The occurrence of immediate complications was more frequent in multifocal spondylodiscitis but with no statistically significant difference (p=0.2).Conclusion:Multifocal sppondylodiscitis is seen mainly in immunocompromised subjects. Our study found that diabetes is the most common factor in immunosuppression. Note also the predominance of involvement of the posterior elements, tuberculous origin and immediate complications.Disclosure of Interests:None declared
Atlas instrumentation guided by the medial edge of the posterior arch: An anatomic and radiologic study
