Tuberculous Spondylodiscitis in South East Tunisia: Features and Predictive Factors of Poor Prognosis

TL;DR

This study examines the features and outcomes of spinal tuberculosis in southeast Tunisia, identifying factors that predict poor prognosis.

Contribution

The study identifies independent predictors of poor outcomes in tuberculous spondylodiscitis in a specific geographic region.

Findings

69.2% of patients had a favorable outcome at one-month follow-up.

Advanced age, delayed diagnosis, spinal cord compression, and elevated CRP levels predict poor outcomes.

Spinal pain was the most common initial symptom in 80.7% of patients.

Abstract

Background: Tuberculous spondylodiscitis is a severe form of tuberculosis (TB) infection. The study aims to determine clinical and radiological features and treatment outcomes of tuberculous spondylodiscitis in southeast Tunisia and to identify factors associated with poor prognosis.

Methods: A retrospective, single-center study was conducted over a period of 16 years (2008-2023). All patients treated for tuberculous spondylodiscitis were included. Data were collected on demographic, clinical, and radiological features, as well as treatment regimens and outcomes. Multivariable logistic regression analysis was performed to identify factors independently associated with unfavorable outcomes.

Results: Twenty-six patients were included in our study, with an average age of 46 years ± 15.69. A female predominance was observed (18 women and eight men). The average symptom duration was 5.6 months ± 4.35. Spinal pain was the revealing functional sign (80.7%). The diagnosis of TB was confirmed in 65.% of patients. Anti-TB treatment was prescribed in all patients with a mean duration of 13.88 ± 3.789 months (10-18 months). At one-month follow-up, 69.2% of patients had a favorable outcome. Independent predictors of poor prognosis included age ≥ 65 years (odds ratio (OR): 2.26), diagnostic delay ≥ 5 months (OR: 1.33), presence of spinal cord compression (OR: 13.9), and initial C-reactive protein (CRP) level ≥ 50 mg/L (OR: 1.24).

Conclusion: In patients with tuberculous spondylodiscitis, the outcome at one month of follow-up was favorable in only 69.2%. Advanced age, delayed diagnosis (≥5 months), spinal cord compression, and elevated CRP levels (≥50 mg/L) emerged as independent predictors of poor outcomes at one-month follow-up. Further studies are required, particularly in TB-endemic countries, to investigate other factors associated with unfavorable outcomes of tuberculous spondylodiscitis.

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