Lee Yangwon, Kim Bum-Joon, Kim Se-Hoon, Lee Seung-Hwan, Kim Won-Hyung, Jin Sung-Won
Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea.
J Korean Neurosurg Soc. 2018 Jan;61(1):81-88. doi: 10.3340/jkns.2016.1212.005. Epub 2017 Dec 29.
Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted.
From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student's t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher's exact test.
The patients' mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, =0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, =0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, =0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, <0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, =0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was (methicillin susceptible and methicillin resistant [MRSA] in 8 and 4 cases, respectively).
The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.
脊柱炎通常对化疗耐药，需要长期治疗。若化疗不充分，后果可能是致命的或导致严重神经损伤。因此，区分脊柱炎的病因非常重要，尤其是在自发性病例中。近年来韩国结核病患病率有所下降，有必要开展关于脊柱炎的最新临床研究。
回顾性收集2010年4月至2016年3月期间脊柱炎患者的数据。共纳入69例患者（51例化脓性脊柱炎患者和18例结核性脊柱炎患者）。评估临床资料、包括红细胞沉降率（ESR）和C反应蛋白（CRP）水平在内的实验室检查结果、初次和末次随访时的Cobb角测量值以及磁共振成像（MRI）扫描的影像学特征。为检验化脓性和结核性两组之间的差异，数值数据采用学生t检验和曼-惠特尼U检验进行比较，分类数据采用卡方检验和费舍尔精确检验进行比较。
患者的平均年龄为60.0岁。男性略占优势（56.5%）。两组之间的平均年龄和性别无差异。化脓性组免疫功能低下患者的比例相对较高。化脓性组的CRP峰值高于结核性组（分别为14.08mg/dL和8.50mg/dL，P=0.009），而两组之间的ESR无显著差异（分别为81.5mm/h和75.6mm/h，P=0.442）。在影像学上，两组之间椎间盘间隙保留和椎体塌陷的情况有所不同。在结核性组中，增强MRI上椎间盘更常得以保留（分别为50%和23.5%，P=0.044），椎体塌陷更常见（分别为66.6%和15.7%，P<0.001）。化脓性组的平均住院时间更长（分别为56.5天和41.2天，P=0.001）。仅在化脓性组观察到4例死亡病例。化脓性组最常分离出的微生物是 （耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌[MRSA]分别为8例和4例）。
自发性脊柱炎的临床和影像学表现因致病微生物而异。化脓性脊柱炎患者往往CRP水平较高，临床病程更严重，而结核性脊柱炎患者椎体破坏伴椎间盘保留更为常见。社区获得性脊柱炎病例中MRSA的出现呈上升趋势。
