Wang D
The National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital (SMH), Aylesbury, Buckinghamshire, UK.
Spinal Cord. 2005 Sep;43(9):531-42. doi: 10.1038/sj.sc.3101753.
Review of medical and radiological records and literature to study the diagnosis of tuberculous vertebral osteomyelitis (TVO) and the differential diagnosis between TVO and pyogenic vertebral osteomyelitis (PVO).
To identify the correct criteria for the diagnosis.
National Spinal Injuries Centre, UK.
(1) Medical and radiological records of 10 patients diagnosed as vertebral osteomyelitis and treated elsewhere but later admitted to the NSIC were reviewed retrospectively. (2) Medical literature on vertebral osteomyelitis were reviewed.
(1) Case review: Before the study, four of the 10 patients TVO had been diagnosed based on positive bacteriology. Of the other six, the diagnosis of PVO had been made in one based on positive blood culture of staphylococcus while in another without any positive result of bacteriology. The diagnosis had been uncertain in four because of negative results of both bacteriology and histology on both tuberculous and pyogenic infection. The author made the diagnosis of TVO in all 10 cases based on clinical manifestations and plain radiographs. Highly raised ESR with moderate rise of or normal WBC in eight cases supported TVO. Computer tomography and magnetic resonance imaging did not contribute to the differential diagnosis. Laminectomy in five patients led to some clinical improvement. The five patients without surgery deteriorated. Two of them died. (2) LITERATURE REVIEW: A total of 188 articles were reviewed. The crucial role of plain radiographs in the diagnosis of TVO and the high incidence of false-negative of tuberculosis in both bacteriological and histological tests were neglected in most articles. Polymerase chain reaction (PCR) was more reliable in diagnosing tuberculosis.
Clinical manifestations, discrepancy between ESR and WBC, plain radiographs and PCR are keys to a correct diagnosis of TVO.
回顾医学和放射学记录及文献，以研究结核性椎体骨髓炎（TVO）的诊断以及 TVO 与化脓性椎体骨髓炎（PVO）之间的鉴别诊断。
确定正确的诊断标准。
英国国家脊髓损伤中心。
（1）回顾性分析 10 例被诊断为椎体骨髓炎并在其他地方接受治疗但后来入住 NSIC 的患者的医学和放射学记录。（2）回顾有关椎体骨髓炎的医学文献。
（1）病例回顾：在研究之前，10例TVO患者中有4例是根据细菌学阳性诊断的。另外6例中，1例根据葡萄球菌血培养阳性诊断为PVO，另1例细菌学检查无阳性结果。4例因结核和化脓性感染的细菌学和组织学检查均为阴性而诊断不确定。作者根据临床表现和X线平片对所有10例患者做出了TVO诊断。8例患者血沉显著升高，白细胞中度升高或正常，支持TVO诊断。计算机断层扫描和磁共振成像对鉴别诊断无帮助。5例患者行椎板切除术临床症状有所改善。5例未手术的患者病情恶化。其中2例死亡。（2）文献回顾：共回顾了188篇文章。大多数文章忽视了X线平片在TVO诊断中的关键作用以及结核在细菌学和组织学检查中假阴性的高发生率。聚合酶链反应（PCR）在诊断结核病方面更可靠。
临床表现、血沉与白细胞的差异、X线平片和PCR是正确诊断TVO的关键。
