An Howard S, Seldomridge J Alex
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Clin Orthop Relat Res. 2006 Mar;444:27-33. doi: 10.1097/01.blo.0000203452.36522.97.
Clinical signs and symptoms caused by spinal infections often are subtle and insidious; therefore, clinical suspicion in patients with nonmechanical pain is important in making the correct diagnosis in the early stage of disease. Serologic tests such as erythrocyte sedimentation rate and C-reactive protein are quite sensitive, but specificity is relatively low. Imaging tests include plain radiographs, radionuclide studies, computed tomography scan, and magnetic resonance imaging. Changes on plain radiographs appear at least 3 to 4 weeks after the onset of disease. Bone scan is a sensitive but not a specific test. Computed tomography provides structural details in the bone and intervertebral disc but magnetic resonance imaging is a superior imaging test for diagnosing infections earlier and more accurately. In many patients, percutaneous or open biopsy is required to make the definitive diagnosis of discitis or osteomyelitis and the organism responsible for the infection. Early and accurate diagnosis of spinal infections will lead to less invasive treatment for the patient.
Level V (Expert Opinion). Please see the Guidelines for Authors for a complete description of levels of evidence.
脊柱感染引起的临床体征和症状往往较为隐匿；因此，对于非机械性疼痛患者保持临床怀疑，对于在疾病早期做出正确诊断很重要。诸如红细胞沉降率和C反应蛋白等血清学检查相当敏感，但特异性相对较低。影像学检查包括X线平片、放射性核素检查、计算机断层扫描（CT）和磁共振成像（MRI）。X线平片上的改变至少在疾病发作后3至4周才出现。骨扫描是一项敏感但不具特异性的检查。CT能提供骨骼和椎间盘的结构细节，但MRI是更早、更准确诊断感染的更优影像学检查。在许多患者中，需要进行经皮或开放活检以明确诊断椎间盘炎或骨髓炎以及感染病原体。早期准确诊断脊柱感染将为患者带来侵入性更小的治疗。
V级（专家意见）。有关证据级别的完整描述，请参阅作者指南。
