Clinical presentation of spondylodiscitis as a long-term complication in incomplete paraplegia: a report of three cases.

Abstract

Case report. Complications in spinal cord injury (SCI) are a challenging problem for the patients and often difficult to manage. Three cases of spondylodiscitis, localized at the lumbosacral junction in long-term paraplegic patients are presented. Spinal Cord Injury Center, Orthopaedic University Hospital Heidelberg, Heidelberg, Germany. In all three cases, neurological deterioration (ASIA A) was caused by a secondary compression of the spinal cord at the lumbosacral spine. Increase of spasticity and pain, atonic bladder and sphincter function accompanied by vegetative symptoms were present in all patients. Microbiological analysis of the sacral area showed coagulase negative staphylococcus in two cases, whereas in one case no microorganism was found. The diagnosis was made by MRI of the whole spine and surgical treatment was required. At follow-up (6 months), patients showed no AIS (ASIA Impairment Scale) changes. If neurological deterioration occurs, spondylodiscitis should be ruled out in paraplegic individuals. The therapeutic goal is to achieve emergent decompression of the spinal cord and to administrate adequate antibiotic therapy to avoid a neurologically complete situation.