Service de rhumatologie, hôpital Nord, CHU d'Amiens, 80054 Amiens cedex 1, France.
Joint Bone Spine. 2010 Jan;77(1):76-7. doi: 10.1016/j.jbspin.2009.10.010. Epub 2009 Dec 21.
Textbooks describe hematogenous discitis in adults as starting in the anterior vertebral body near the endplates.
Hematogenous Staphylococcus aureus discitis developed at L1-L2 in an 81-year-old woman. On the first magnetic resonance imaging (MRI) scan performed 4 days after symptom onset, the only abnormalities were high signal from the disk on T2-weighted images, gadolinium enhancement of the soft tissues anterior to L1-L2, and epidural involvement. The endplates and vertebral bodies were normal. A subsequent MRI scan showed features typical of infectious discitis.
We found a single similar case report in the medical literature, indicating that discitis starting outside the anterior vertebral body is rare. Nevertheless, an increasing number of similar cases may be diagnosed in the future, as MRI is being performed increasingly early in patients with a clinical suspicion of infectious discitis.
Hematogenous infectious discitis in adults may start in some patients within the disk, soft tissues anterior to the disk, or epidural space. To avoid diagnostic and therapeutic delays, physicians should be aware of this unusual presentation of infectious discitis on very early MRI scans. When the clinical picture suggests discitis and findings from the early MRI scan are atypical, a repeat MRI scan should be obtained 1 week later to confirm the diagnosis.
教科书描述成人血源性椎间盘炎始于终板附近的前椎体。
一位 81 岁女性发生血源性金黄色葡萄球菌椎间盘炎，病变位于 L1-L2。在症状出现后 4 天进行的第一次磁共振成像（MRI）扫描中，仅有的异常是 T2 加权图像上椎间盘的高信号、L1-L2 前方软组织的钆增强以及硬膜外受累。终板和椎体正常。随后的 MRI 扫描显示出感染性椎间盘炎的典型特征。
我们在医学文献中仅发现了一例类似的病例报告，表明从前椎体外部开始的椎间盘炎很少见。然而，随着对疑似感染性椎间盘炎患者进行 MRI 检查的时间越来越早，未来可能会诊断出越来越多类似的病例。
成人血源性感染性椎间盘炎可能在某些患者中首先出现在椎间盘内、椎间盘前方的软组织内或硬膜外间隙。为避免诊断和治疗延误，医生应该意识到这种不常见的感染性椎间盘炎在非常早期的 MRI 扫描上的表现。当临床表现提示椎间盘炎且早期 MRI 扫描的结果不典型时，应在 1 周后再次进行 MRI 扫描以确认诊断。
