Euba Gorane, Narváez José A, Nolla Joan M, Murillo Oscar, Narváez Javier, Gómez-Vaquero Carmen, Ariza Javier
Infectious Disease Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
Semin Arthritis Rheum. 2008 Aug;38(1):28-40. doi: 10.1016/j.semarthrit.2007.08.007. Epub 2007 Dec 11.
Management of abscess-associated spontaneous pyogenic vertebral osteomyelitis (PVO) is controversial. The role of magnetic resonance imaging (MRI) in follow-up and its relation with clinical outcome is often unclear. This study evaluates the clinical and MRI outcome of abscess-associated PVO under conservative treatment.
Prospective study and retrospective review of patients with spontaneous PVO in whom the initial MRI showed soft-tissue involvement (STI). Treatment according to a medical protocol, clinical and MRI follow-up at diagnosis, and at 2 later time points: early response (ER, at the end of antibiotic therapy) and late response (LR, >or=6 months after therapy). MRI classified STI as soft-tissue edema (STE) or abscess.
Of the 27 patients (20 men, 74%, age 65+/-14), all had pain, 17 (63%) had fever, and 6 (22%) had mild neurological impairment. The main etiology was Staphylococcus sp (11, 41%). Twenty-one (81%) had bacteremia and 18 (67%) had epidural/paraspinal abscess. Patients received antibiotics for 9 weeks, administered orally for 6 weeks. ER: Three cases failed and general improvement was seen in the remainder. MRI showed persistent STI, which diminished in all cases except 1, whereas bone/disc findings remained. LR: All patients were cured; 8 reported mild sequelae (30%). MRI still revealed bone/disc abnormalities, but residual STE was infrequent. Median follow-up was 29 months.
Most patients with abscess-associated spontaneous PVO are cured with a conservative approach. MRI shows STI reduction at ER evaluation. Repeat MRI is probably unnecessary if clinical and laboratory outcomes are satisfactory. The persistence of bone/disc MRI findings alone does not represent therapeutic failure.
脓肿相关性自发性化脓性脊椎骨髓炎（PVO）的治疗存在争议。磁共振成像（MRI）在随访中的作用及其与临床结果的关系通常不明确。本研究评估了保守治疗下脓肿相关性PVO的临床和MRI结果。
对初始MRI显示有软组织受累（STI）的自发性PVO患者进行前瞻性研究和回顾性分析。按照医疗方案进行治疗，在诊断时以及随后的两个时间点进行临床和MRI随访：早期反应（ER，抗生素治疗结束时）和晚期反应（LR，治疗后≥6个月）。MRI将STI分为软组织水肿（STE）或脓肿。
27例患者（20例男性，占74%，年龄65±14岁），均有疼痛，17例（63%）有发热，6例（22%）有轻度神经功能障碍。主要病因是葡萄球菌属（11例，占41%）。21例（81%）有菌血症，18例（67%）有硬膜外/椎旁脓肿。患者接受了9周的抗生素治疗，口服6周。早期反应：3例治疗失败，其余患者总体情况有所改善。MRI显示STI持续存在，除1例外在所有病例中均有所减轻，而骨/椎间盘病变依然存在。晚期反应：所有患者均治愈；8例报告有轻度后遗症（30%）。MRI仍显示骨/椎间盘异常，但残留STE不常见。中位随访时间为29个月。
大多数脓肿相关性自发性PVO患者采用保守治疗可治愈。在早期反应评估时MRI显示STI减轻。如果临床和实验室结果令人满意，可能无需重复进行MRI检查。仅骨/椎间盘MRI表现持续存在并不代表治疗失败。
