Narváez Javier, Nolla Joan M, Narváez José A, Martinez-Carnicero Laura, De Lama Eugenia, Gómez-Vaquero Carmen, Murillo Oscar, Valverde José, Ariza Javier
Rheumatology Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
Semin Arthritis Rheum. 2006 Apr;35(5):272-83. doi: 10.1016/j.semarthrit.2005.09.003.
To analyze the clinical features, approaches to management, and outcome of spontaneous pyogenic facet joint infection (PFJI) in adults.
Case series of 10 adults with microbiologically proven PFJI diagnosed during a 10-year period in a teaching hospital, plus a review of 32 additional cases previously reported (PubMed 1972 to 2003). Patients with prior spinal instrumentation or surgery and injection drug users were excluded. Only cases that were sufficiently detailed to be individually analyzed were included. These 32 cases, together with our 10 patients, form the basis of the present analysis.
PFJI represented nearly 20% of all spontaneous pyogenic spinal infection diagnosed in our hospital during a 10-year period. This data suggest that PFJI is more common than was previously thought. Of the 42 patients with PFJI, 26 (62%) were men and 16 (38%) were women, with ages ranging from 20 to 86 years (mean age, 59+/-15 years); 55% of patients were older than 60 years. The most common location of infections was the lumbosacral region (86%). All patients presented with severe back pain; fever was noted in 83% of the cases and neurological impairment in nearly 48%. In 38% of patients a systemic predisposing factor for infection was present; the most common conditions were diabetes mellitus, malignancies, and alcoholism. In almost 36% of cases, one or more concomitant infectious processes due to the same microorganism was found, mainly arthritis, skin and soft-tissue infections, endocarditis, and urinary tract infections. Staphylococcus aureus was the most common etiologic microorganism (86% of cases). Bacteremia was documented in 81% of the cases. The diagnosis of PFJI was based mainly on imaging study findings. Paraspinal and/or epidural extension was frequent (81% of cases), but its presence did not indicate a worse prognosis. Medical treatment alone was usually successful. The overall prognosis of PFJI was good, with a mortality rate of only 2%. The great majority of patients were cured without functional sequelae.
Incidence data from our institution reveal that PFJI is not a rare condition, representing approximately 20% of all pyogenic spinal infections. This entity should be considered in the differential diagnosis of patients with low back pain, especially in the presence of fever, whatever the patient's immunological status.
分析成人自发性化脓性小关节感染（PFJI）的临床特征、治疗方法及预后。
这是一个病例系列研究，纳入了10例在一所教学医院10年间确诊的经微生物学证实的PFJI成人患者，并回顾了另外32例先前报道的病例（PubMed检索时间为1972年至2003年）。排除既往有脊柱内固定或手术史的患者以及注射吸毒者。仅纳入细节充分可单独分析的病例。这32例病例与我们的10例患者构成了本分析的基础。
在10年期间，PFJI占我院诊断的所有自发性化脓性脊柱感染的近20%。该数据表明PFJI比之前认为的更为常见。42例PFJI患者中，男性26例（62%），女性16例（38%），年龄范围为20至86岁（平均年龄59±15岁）；55%的患者年龄超过60岁。感染最常见的部位是腰骶部（86%）。所有患者均有严重背痛；83%的病例有发热表现，近48%的病例有神经功能损害。38%的患者存在全身性感染易感因素；最常见的情况是糖尿病、恶性肿瘤和酗酒。在近36%的病例中，发现一种或多种由同一微生物引起的伴随感染性疾病，主要是关节炎、皮肤和软组织感染、心内膜炎及尿路感染。金黄色葡萄球菌是最常见的病原微生物（86%的病例）。81%的病例记录有菌血症。PFJI的诊断主要基于影像学检查结果。椎旁和/或硬膜外扩展很常见（81%的病例），但其存在并不预示预后更差。单纯药物治疗通常是成功的。PFJI的总体预后良好，死亡率仅为2%。绝大多数患者治愈且无功能后遗症。
我们机构的发病率数据显示PFJI并非罕见疾病，约占所有化脓性脊柱感染的20%。在腰痛患者的鉴别诊断中应考虑到这种疾病，尤其是伴有发热时，无论患者的免疫状态如何。
