Outcomes of surgical management of patients with infective spondylodiscitis at Mulago hospital

Abstract

Background: Infective spondylodiscitis is a very challenging condition to treat even in the hands of the most experienced spine surgeon and it is one of the most significant sources of back pain and a considerable impact on the ability to perform activities of daily living. Patients with Spondylodiscitis present generally late in our setting. Delayed presentation of more than 3months has been associated with poor outcome after surgery. Hence the need to know the short-term outcome of these surgical procedures in our setting. Objective: To determine the clinical and functional outcomes of patients with infective spondylodiscitis who have been surgically managed at Mulago National Referral Hospital. Methods: This was a cross sectional study that recruited 39 patients who were in the short-term period of 6- 36 months from the time of surgery for spondylodiscitis. Self-structured questionnaires were used for data collection in addition to review of patient’s files, Clinical examination for change in neurologic deficit and validated tools. ASIA impairment scale and Visual analogue scale (VAS) scale were used to assess clinical outcome while the Modified Oswestry Disability Index was used to assess functional outcomes. Bivariate and multivariate analysis were done for factors that affect outcome and a P-value less than 0.05 was considered statistically significant Results: Majority of the patients (29 out of 39) were male and 71.9% participants being below 50years with mean age of 44.2years (±23.7). Majority of the patients (69.2%) were staying in rural areas. Most patients (79.1%) had HIV as risk factor and majority had TB spondylodiscitis (71.8%). 5.1% reported depression after surgery on account of failure to improve after surgery. The VAS score improved from 7.8cm before surgery to a mean of 1.8cm after surgery. Patients improved by at least one grade on the ASIA scale except two patient who deteriorated. Functional outcome as assessed by M-ODI score; majority (66.7%) recovered completely. The mean M-ODI improved from 78 ± 9.2 before surgery to a mean of 24.3 ± 5.8 after surgery. Conclusion: Surgical management of patients with infective spondylodiscitis results in improved clinical and functional outcomes by improving disability and symptoms.