Department of Spine Surgery, Shandong Provincial Hospital Affiliated To Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 in Jingshi Road, Jinan City, China.
Department of Neurology, The First affiliated Hospital of Shandong First Medical University; Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan City, China.
Eur Spine J. 2020 Jul;29(7):1490-1498. doi: 10.1007/s00586-019-06214-8. Epub 2019 Nov 21.
Both pyogenic spondylitis (PS) and brucellar spondylitis (BS) can cause deformities and permanent neurologic deficits without prompt diagnosis and treatment. However, differential diagnosis is challenging. The aim of this study was to compare the computed tomography (CT) imaging features of PS with those of BS.
Thirty-two patients with PS and 44 with BS were enrolled in the study. CT images were obtained in all cases. Data on bone destruction and formation, vertebral wall destruction, and osteosclerotic changes were collected and compared using the Chi-square test or t test. A P value < 0.01 was considered statistically significant. Positive predictive values (PPV) for detecting PS or BS were reported.
Involvement of the lumbar vertebrae and multiple spinal levels was more common in the BS group than in the PS group. Bone destruction was significantly greater in the PS group than in the BS group (30.8 vs 18.0%; t = 3.920, P = 0.000), with more extensive destruction of the vertebral body (35.8 vs 12.5%, χ = 12.672, P = 0.002, PPV = 63.16%). In the BS group, there was more osteosclerosis around erosions (70.5 vs 43.3%, χ = 11.59, P = 0.001, PPV = 67.74%) and fan-shaped osteosclerosis (27.3 vs 19.4%, χ = 18.556, P = 0.006, PPV = 64.86%), more bone formation around the vertebra (77.2 vs 34.3%, χ = 33.608, P = 0.000, PPV = 76.83%), more bone formation under the anterior longitudinal ligament (63.6 vs 19.4%, χ = 30.133, P = 0.000, PPV = 76.09%), more longer anterior bone formation (3.55 vs 0.78 mm, t = 3.997, P = 0.000), and more anterior and closed-bone formation with local erosion (42.0 vs 9.0%, χ = 74.243, P = 0.000, PPV = 74.36%).
CT images have unique advantages of revealing the morphology of erosions, osteosclerosis, and bone formation around the vertebra and help to differentiate PS from BS. These slides can be retrieved under Electronic Supplementary Material.
化脓性脊柱炎（PS）和布鲁氏菌性脊柱炎（BS）均可导致畸形和永久性神经功能缺损，如果不及时诊断和治疗，后果严重。然而，鉴别诊断具有挑战性。本研究旨在比较 PS 和 BS 的 CT 成像特征。
纳入 32 例 PS 患者和 44 例 BS 患者，均行 CT 检查。收集并比较骨破坏和形成、椎体壁破坏和骨硬化改变的数据，采用卡方检验或 t 检验。P 值<0.01 为差异有统计学意义。报告 PS 或 BS 的阳性预测值（PPV）。
BS 组中腰椎和多个脊柱水平受累的比例高于 PS 组。PS 组的骨破坏程度显著大于 BS 组（30.8%比 18.0%；t=3.920，P=0.000），椎体破坏更为广泛（35.8%比 12.5%，χ²=12.672，P=0.002，PPV=63.16%）。BS 组侵蚀周围的骨硬化更为明显（70.5%比 43.3%，χ²=11.59，P=0.001，PPV=67.74%）和扇形骨硬化（27.3%比 19.4%，χ²=18.556，P=0.006，PPV=64.86%），椎体周围的骨形成更多（77.2%比 34.3%，χ²=33.608，P=0.000，PPV=76.83%），前纵韧带下的骨形成更多（63.6%比 19.4%，χ²=30.133，P=0.000，PPV=76.09%），更长的前骨形成（3.55 毫米比 0.78 毫米，t=3.997，P=0.000），前侧和闭合性骨形成伴局部侵蚀（42.0%比 9.0%，χ²=74.243，P=0.000，PPV=74.36%）。
CT 图像具有揭示侵蚀、骨硬化和椎体周围骨形成形态的独特优势，有助于 PS 与 BS 相鉴别。幻灯片可在电子补充材料中查看。
