Lozano María Carmen, García-Agudo Lidia, Moreno Raquel, Chozas Nicolás, García-Martos Pedro
Microbiología, Hospital Universitario Puerta del Mar, España.
Rev Med Chil. 2010 Oct;138(10):1272-5. Epub 2011 Jan 10.
Tuberculous spondylodiscitis is relatively uncommon but represents the most common location of osseous tuberculosis.
To describe clinical features, imaging studies and laboratory tests to establish the diagnosis in a group of patients living in Cádiz (Spain).
Retrospective analysis of medical records of patients with tuberculous spondylodiscitis diagnosed between 2000 and 2009. The diagnosis was based on microorganism recovery from vertebral samples obtained by imaging guided biopsies.
Six patients with positive Mycobac-terium tuberculosis cultures from vertebral samples, were identified (10% of extra-pulmonary tuberculosis). In only 2 patients the Ziehl-Nielsen stain was positive, and histology was compatible in 4 cases. Four patients were females, their mean age was 54.3 years and the mean duration of symptoms was 7.3 months. Three patients had lumbar location and a positive Mantoux test. A soft tissue abscess was present in 4 cases. None of these patients had neurological complications. The treatment with four tuberculostatic agents (isoniazid, rifampicin, pyrazinamide and ethambutol) was effective in 5 patients.
Tuberculous spondylodiscitis may become a serious disease due to diagnostic and treatment delays. The main examinations to establish diagnosis are magnetic resonance imaging and biopsy with microbiological culture. Generally, antituberculous therapy is effective in this clinical situation.
结核性脊椎椎间盘炎相对少见，但却是骨结核最常见的发病部位。
描述在一群居住于西班牙加的斯的患者中，用于确诊结核性脊椎椎间盘炎的临床特征、影像学检查和实验室检查。
对2000年至2009年间确诊为结核性脊椎椎间盘炎的患者病历进行回顾性分析。诊断基于通过影像引导活检从椎体样本中培养出微生物。
确定了6例椎体样本结核分枝杆菌培养阳性的患者（占肺外结核的10%）。仅2例患者齐-尼氏染色呈阳性，4例组织学检查符合诊断。4例为女性，平均年龄54.3岁，平均症状持续时间7.3个月。3例患者病变位于腰椎，结核菌素试验呈阳性。4例患者存在软组织脓肿。这些患者均无神经并发症。5例患者采用四种抗结核药物（异烟肼、利福平、吡嗪酰胺和乙胺丁醇）治疗有效。
由于诊断和治疗延误，结核性脊椎椎间盘炎可能会成为一种严重疾病。确诊的主要检查是磁共振成像和微生物培养活检。一般来说，抗结核治疗在这种临床情况下是有效的。
