Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, Madrid, Spain.
Int Orthop. 2012 Feb;36(2):239-44. doi: 10.1007/s00264-011-1445-x. Epub 2012 Jan 4.
The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included.
We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/- 16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI).
In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %).
Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.
对于化脓性椎间盘炎的最佳治疗方案尚未达成共识。本研究采用回顾性、横断面、观察性研究方法，纳入了 1999 年 1 月至 2009 年 1 月期间在马德里圣卡洛斯医院就诊的所有化脓性椎间盘炎患者。
共纳入 108 例连续成年化脓性椎间盘炎患者，其中男 49 例，女 59 例，平均年龄 67.5（+/-16.89）岁。平均随访时间为 6.06（12.5-2）年。78 例为自发性椎间盘炎，30 例为术后椎间盘炎。纳入本研究的标准为符合脊柱感染的疾病表现，或 MRI 显示脊柱受累的证据。
56 例行经皮椎间盘活检（52%的患者），其中 28 例阳性。100 例患者单个椎间盘受累，受累节段包括颈椎 4 例，胸椎 38 例，腰椎 66 例。108 例患者中 73 例（68%）存在 1 种或多种合并症，最常见的合并症为糖尿病。4 例合并症导致患者快速死亡，7 例最终死亡，97 例（90%）患者非致死或无合并症。
早期诊断是一个主要挑战。提高警惕并及时应用 MRI 检查有助于避免诊断延迟。延长抗菌药物治疗时间并适时进行手术干预对于获得良好的预后至关重要。
