Del Pozo F Javier Fonseca, Alonso Joaquín Valle, Ruiz Miguel Ángel Caracuel, Vythilingam Siyamini, Ruiz Daniel Lopez
Family physician and Prehospital Emergency Medicine, Montoro, Cordoba, Spain.
Emergency Physician, Royal Bournemouth Hospital, UK.
Bull Emerg Trauma. 2016 Jul;4(3):174-9.
Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, with an irregular high intensity area at L2; suggesting a fluid collection extending to adjacent soft tissues. Fluoroscopy-guided core needle bone biopsies were reported positive for Escherichia coli sensitive to ceftriaxone. The patient was treated (received treatment) with a three week course of ceftriaxone following a formal diagnosis of E. coli spondylodiscitis. Follow-up MRI demonstrated complete recovery with the patient able to return (has returned) to normal activity. In this case we highlight the importance of correct and timely diagnosis of spondylodiscitis. Diagnosis of spondylodiscitis is often difficult, delayed or even missed due to the rarity of the disease but can lead to devastating consequences. Therefore a high index of suspicion is needed for prompt diagnosis to ensure improved long-term outcomes.
脊椎骨髓炎，即椎间盘炎，是一种罕见疾病，近年来由于脊柱外科手术增多、医院获得性菌血症、人口老龄化以及静脉药物成瘾，其患病率呈上升趋势。血源性感染是椎间盘炎最常见的病因。我们报告一例47岁男性被诊断为大肠杆菌性椎间盘炎。患者最初表现为下背部炎性机械性疼痛4天，提示坐骨神经痛。治疗包括使用非甾体抗炎药和阿片类药物。因上消化道出血入院出院两天后，背痛加剧，促使其再次前往急诊科就诊；期间腰骶部X线摄影显示L2/L3椎间隙明显变窄。因症状加重和炎症指标升高再次入住风湿科后，加急磁共振成像（MRI）显示L2/L3椎间盘间隙消失，L2处有不规则高强度区域；提示液体积聚延伸至相邻软组织。透视引导下的芯针骨活检报告显示大肠杆菌对头孢曲松敏感。在正式诊断为大肠杆菌性椎间盘炎后，患者接受了为期三周的头孢曲松治疗。随访MRI显示完全恢复，患者已能恢复正常活动。在本病例中，我们强调了正确及时诊断椎间盘炎的重要性。由于该病罕见，椎间盘炎的诊断往往困难、延迟甚至漏诊，但可能导致严重后果。因此，需要高度怀疑以进行及时诊断，以确保改善长期预后。
