Spondylodiscitis in patients under haemodyalisis

Abstract

Purpose: The purpose of this study was to reach conclusions about the diagnosis and treatment of a series of patients with spondylodiscitis under haemodialysis treatment.

Methods: We collected and studied 23 patients included in a prospective database from two neighbouring hospitals. Descriptive statistical analysis was performed.

Results: The diagnosis was frequently made very late and early negative cultures were not uncommon; magnetic resonance images allowed for an early diagnosis with accurate anatomical information. Empirical antibiotic treatment with prompt surgery produced good results in patients under risk of, or having neurological problems. Surgical approaches did not differ from pyogenic or tuberculous spondylodiscitis. Age in our series was not a predictive issue.

Conclusions: Whenever a patient under haemodialysis has symptoms of spinal disease, particularly back pain with fever, they should undergo an MRI. If diagnosis of spondylodiscitis is made prompt empirical antibiotherapy should be instituted. Blood cultures should be performed and tissue samples taken for cultures; however, culture outcome must not delay therapy. Early surgical decompression leads to good results.

Fig. 1

a A 78-year-old diabetic woman under haemodialysis presented with back pain for one month. X-ray showed aortic arteriosclerosis, L4-L5 discopathy, and some other degenerative changes. No other abnormalities were found. b MRI showed a L2-L1 spondylodiscitis. c Anterior retroperitoneal approach allowed debridement with disk removal and vertebral bodies curettage. d The gap was filled with a tricortical iliac crest bone graft. Vertebral bodies were plated also anteriorly. e X-ray view after one-year follow-up (AP view). f. X-ray after one-year follow-up (lateral view)