Pintado-García Vicente
Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.
Enferm Infecc Microbiol Clin. 2008 Oct;26(8):510-7.
Vertebral osteomyelitis or spondylodiscitis is an uncommon, mainly hematogenous, disease that usually affects adults. The incidence of this condition has steadily risen in recent years because of increases in spine surgery and nosocomial bacteremia, aging of the population, and intravenous drug addiction. Pyogenic infection due to Staphylococcus aureus is the most frequent form of the disease, but tuberculosis and brucellosis are still common causes of spondylitis in Spain. The clinical presentation is nonspecific and the diagnosis is often delayed. Magnetic resonance imaging is the most sensitive radiologic technique for this disease. Blood cultures are often positive, but computed tomography-guided needle biopsy or surgical biopsy of the affected vertebra is sometimes required to achieve a microbiological diagnosis. Prolonged antibiotic therapy and occasionally surgery are essential for cure in most patients, and both factors have contributed to a reduction in the morbidity and mortality of the disease in recent years.
脊椎骨髓炎或椎间盘炎是一种罕见的疾病,主要通过血行感染,通常影响成年人。近年来,由于脊柱手术和医院获得性菌血症的增加、人口老龄化以及静脉药物成瘾,这种疾病的发病率稳步上升。金黄色葡萄球菌引起的化脓性感染是该病最常见的形式,但在西班牙,结核病和布鲁氏菌病仍是脊柱炎的常见病因。临床表现不具有特异性,诊断往往延迟。磁共振成像(MRI)是诊断该病最敏感的影像学技术。血培养通常呈阳性,但有时需要计算机断层扫描(CT)引导下的穿刺活检或对受累椎体进行手术活检以做出微生物学诊断。延长抗生素治疗时间,有时还需要手术,这对大多数患者的治愈至关重要,近年来这两个因素都有助于降低该病的发病率和死亡率。