2026, Number 2
Etiology of vertebral destruction syndrome in a Third Level Hospital in Mexico City
Full text
10.35366/122612
Language: English/Spanish [Versión en español]
References: 18
Page: 108-111
PDF size: 239.39 Kb.
ABSTRACT
Introduction: vertebral destruction syndrome encompasses pathologies that cause structural alterations in the vertebral body, producing deformity with neurological, mechanical, infectious, tumoral, and metabolic involvement. Objective: to identify the most frequent etiology of vertebral destruction syndrome in the population of the Ignacio Zaragoza "General Regional Hospital". Material and methods: a cross-sectional, descriptive, retrospective, observational study was carried out during the period from January 2019 to December 2023, in patients of both genders, hospitalized with a confirmed diagnosis of vertebral destruction syndrome, with a complete clinical record. Results: a sample of 99 patients with a diagnosis of vertebral destruction syndrome was obtained, reporting tumor etiology in 36.3% followed by infectious etiology in 33.3%, and metabolic etiology in 30.3%; with a gender report of 85.5% female and 14.5% male, predominating in the age range of 65 to 70 years. Conclusion: vertebral destruction syndrome is more common in the female sex in the age range of 65 to 70 years, with tumor etiology being the most prevalent due to metastatic lesions that comprise nearly 97% of all spinal tumors, followed by infectious etiology due to vertebral osteomyelitis, and osteoporosis due to a crush fracture.INTRODUCTION
Vertebral destruction syndrome is a pathology that causes structural alterations of the spine, mainly in the vertebral body, producing deformity, neurological involvement, and spinal instability. The main causes include infectious, tumor, and metabolic etiologies.1
In infectious etiology, the most important organism is Staphylococcus aureus, seen in more than 50% of cases in developing countries, followed by the tuberculosis bacillus.2 Infection by Brucella melitensis, Pseudomonas aeruginosa, and Candida spp. can also be found,3-5 resulting in clinical pictures of vertebral osteomyelitis and spondylodiscitis, mainly due to hematogenous spread in bacteremia and invasive diagnostic and therapeutic procedures.6,7
Tumor etiology occurs mainly due to metastasis from tumors of lung, prostate, breast, and kidney origin,8,9 which can initiate from local or adjacent lesions to the spine or at a distance, spread via hematogenous or lymphatic routes.10,11
In metabolic etiology, osteoporosis is the most relevant metabolic process, as it can give rise to a crush fracture that causes destruction of the vertebral body and its deformity.12 Other pathologies to consider are osteomalacia and Paget's disease.13
Patients with vertebral destruction syndrome present an insidious progression, and a delay between the onset of symptoms and diagnosis is common, with pain being the most frequent symptom, which is usually progressive, slow, and not associated with physical activity; it is typically uncomfortable at night and associated with motor and sensory deficits specific to the affected spinal segment.14 Likewise, they may present systemic symptoms such as weight loss, fatigue, and fever.15
The diagnosis of the group of pathologies that cause vertebral destruction syndrome is related to clinical, imaging, and laboratory data—such as an increase in C-reactive protein and erythrocyte sedimentation rate—and specific findings for each pathology, highlighting the use of magnetic resonance imaging and bone scintigraphy, with biopsy generally being the most important element for the etiological diagnosis.16,17
The diagnostic process sometimes does not derive the expected result, leading to a late diagnosis with underlying complications; therefore, it is necessary to seek to understand the main diseases, etiological agents, or pathologies that trigger vertebral destruction syndrome.18
The objective is to identify the etiology of vertebral destruction syndrome in the Mexican population, since an etiology within this population has not yet been described.
MATERIAL AND METHODS
A cross-sectional, descriptive, retrospective, and observational study was conducted during the period from January 2019 to December 2023. The inclusion criteria were patients of both sexes, hospitalized with a confirmed diagnosis of vertebral destruction syndrome and with a complete clinical record. The exclusion criteria for cases and controls were patients treated outside the study period and incomplete clinical records.
With the approval of the Research Committee of the Hospital Regional "General Ignacio Zaragoza", a review of the physical and electronic records of patients who met this diagnosis was performed for a non-probability convenience sampling.
The variables to be analyzed were age, sex, etiology, preexisting diseases, laboratory tests, imaging studies, biopsies, and cultures, which were entered and collected in a database in an Excel file for subsequent statistical analysis. Processing was carried out using the statistical package SPSS version 22.
RESULTS
A total of 99 patients with a diagnosis of vertebral destruction syndrome registered at the Hospital Regional "General Ignacio Zaragoza" of ISSSTE were obtained between January 2019 and December 2023.
The presentation in relation to sex was a total of 85 female patients (85.5%) and 14 male patients (14.5%) (Figure 1); the age ranges of presentation found were from 28 up to 90 years of age, with a higher prevalence found in the age range of 65 to 70 years (28.28%) with a total of 28 patients, followed by 60-64 years with a total of 18 patients (18.18%), and 75 to 80 years with 17 patients (17.17%) (Figure 2).
The most frequent site of involvement by spinal level reported was the lumbar spine in 100% of cases of infectious etiology; in relation to tumor etiology, the sites of involvement were at the thoracic level with 44.44%, the lumbar level with 47.22%, and the cervical level with 8.3%. The most prevalent involvement by metabolic etiology was the thoracic region in 71.28% and the lumbar region in 26.73% (Figure 3).
The most prevalent symptomatology was pain in 79.2% with 80 patients, functional limitation in 47.52% with 48 cases, and fever in 26.73% with 27 cases.
Tumor etiology was recorded in 36.3% with a total of 36 reported cases, of which 35 of the reported cases (97%) were secondary to metastasis originating from different organs, where breast cancer had the highest prevalence (44%), which could explain the higher prevalence we had in women with respect to the male sex, followed by prostate cancer (8%) and subsequently thyroid, ovary, and non-Hodgkin lymphoma (6%), and only one reported case was of primary origin.
Infectious etiology was reported at 33.3%, with a total of 33 reported cases, of which the most reported etiological agent was Staphylococcus aureus, being reported in cultures from 23 patients.
Metabolic etiology presented in 30 cases (30.3%), highlighting the presence of osteoporosis in 90% of the collected diagnoses (Figure 4).
DISCUSSION
Through this research conducted at the Hospital Regional "General Ignacio Zaragoza" of ISSSTE, which sought to understand the etiology of vertebral destruction syndrome and its epidemiological profile, we found that this condition was more common in females in an age range of 65 to 70 years, and the most prevalent etiology was tumor, with metastatic lesions being the most reported.
In a study conducted by the Instituto Nacional de Rehabilitación, it was reported that the average age of presentation in vertebral destruction syndrome was 56.7 ± 19.4 years (range 9-95). Females accounted for 58.7% of the patients and males for 41.3%. The most affected vertebrae were the lumbar vertebrae (66.7%), with L1 and L3 occupying the first and second place, respectively. These data are comparable to those found in this research, as a higher prevalence was found in females, within a similar age range of presentation, and the affected segments of the spine were—in most cases—at the lumbar level, followed by the thoracic spine.
According to the literature, the primary tumors that most frequently disseminate to the spine originate from lung, prostate, breast, and kidney cancer, of which the main ones reported in this study were breast cancer, reaching up to 50%, and prostate cancer, which reached 75% of patients with the diagnosis of vertebral destruction syndrome.
Regarding infectious etiology, in the cultures collected from patients, the presence of Staphylococcus aureus was found in 10 patients with surgical history prior to the diagnosis of infectious etiology vertebral destruction syndrome. In the literature, it is reported that Staphylococcus aureus is responsible for nearly 60% of spinal infections, followed by the tuberculosis bacillus; however, in the current study, no report of tuberculosis infection was found.
Regarding metabolic etiology, osteoporosis was the most reported diagnosis in almost all cases, which is in line with what is reported in the literature, this being the most frequent metabolic process affecting the spine, generating vertebral crush fractures that cause lumbar or middle and lower back pain, and spinal deformity.
CONCLUSIONS
Vertebral destruction syndrome is a pathology of multifactorial etiology that causes alterations in the structure of the spine, generating functional limitation and deterioration of the quality of life in the adult population, predominantly in an age range of 65 ± 10 years. It presents a higher involvement in females (60%) and can progress toward deformities in spinal mechanics, as well as the appearance of neurological alterations.
Sometimes, the diagnostic process does not lead to the expected result, giving rise to delayed diagnoses and the presence of underlying complications. Therefore, it is fundamental to identify the main preexisting diseases and etiological agents that underlie or trigger vertebral destruction syndrome, in order to improve prevention, timely diagnosis, treatment, and prognosis, as well as to reduce healthcare costs.
Finally, some limitations of the study must be recognized, such as the sample size and the lack of a complete protocol in the diagnosis of each of the reported cases, which could have led to an overestimation of the results. Future research should reconfirm these findings by conducting larger-scale studies.
REFERENCES
AFFILIATIONS
1 Facultad Mexicana de Medicina, Universidad La Salle México. Ciudad de México, México.
2 Traumatología y Ortopedia, Hospital Regional "General Ignacio Zaragoza", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado. Ciudad de México, México.
ORCID:
3 0009-0006-8288-0700
4 0000-0002-2985-9009
5 0000-0003-2316-2056
6 0000-0002-8117-5683
7 0009-0007-9235-770X
8 0009-0006-1147-8175
If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx
CORRESPONDENCE
Josué Ramos Texta. Correo electrónico: josue.rt2410@gmail.comReceived: 2024-12-27. Accepted: 2025-02-10.