Maeda Yuki, Izawa Kazutaka, Nabeshima Takaharu, Yonenobu Kazuo
Department of Orthopaedic Surgery, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan.
J Orthop Sci. 2008 Jan;13(1):16-20. doi: 10.1007/s00776-007-1197-z. Epub 2008 Feb 16.
Although the number of patients with tuberculous spondylitis in Japan is increasing slowly, the proportion of the elderly among these patients is increasing more quickly. The purpose of this study was to describe the clinical features and diagnostic imaging findings in elderly tuberculous spondylitis patients in order to enhance diagnosis of the condition in the elderly population.
We conducted a retrospective review of 23 patients over 70 years of age previously diagnosed with tuberculous spondylitis. Clinical signs and symptoms, including local pain, fever, and neurological deficits, were analyzed. Routine laboratory tests, including the erythrocyte sedimentation rate, the white blood cell count, and the C-reactive protein level were also reviewed. The results of plain X-rays and magnetic resonance imaging were studied.
Patients' signs and symptoms were as follows: local pain in 19 patients (83%); fever in 7 patients (30%) and no fever in 16 patients (70%); and neurological deficits in 13 patients (57%). C-Reactive protein was less than 1.0 mg/dl in 6 patients (26%). Radiography revealed several changes in the affected vertebrae; 3 patients had atypical changes involving only a single vertebra.
It is difficult to diagnose tuberculous spondylitis in the elderly because there are atypical symptoms, a scarcity of inflammatory changes, and degenerative changes normally seen in the elderly may mask the radiographic changes due to tuberculous spondylitis. Tuberculous spondylitis should be considered a possibility in the differential diagnosis of back pain in the elderly, especially in countries with a significant history of tuberculosis in the population.
尽管日本结核性脊柱炎患者数量在缓慢增加，但这些患者中老年人的比例增长更快。本研究的目的是描述老年结核性脊柱炎患者的临床特征和诊断影像学表现，以提高老年人群中该病的诊断水平。
我们对23例70岁以上先前诊断为结核性脊柱炎的患者进行了回顾性研究。分析了包括局部疼痛、发热和神经功能缺损在内的临床症状和体征。还回顾了包括红细胞沉降率、白细胞计数和C反应蛋白水平在内的常规实验室检查结果。研究了X线平片和磁共振成像的结果。
患者的症状和体征如下：19例（83%）有局部疼痛；7例（30%）发热，16例（70%）无发热；13例（57%）有神经功能缺损。6例（26%）患者的C反应蛋白低于1.0mg/dl。X线检查显示受累椎体有多处改变；3例患者有仅累及单个椎体的非典型改变。
老年结核性脊柱炎难以诊断，因为存在非典型症状、炎症改变较少，且老年人常见的退行性改变可能掩盖结核性脊柱炎引起的影像学改变。在老年人背痛鉴别诊断中应考虑结核性脊柱炎的可能性, 尤其是在有显著结核病历史的国家。
