Fan Zihan, Yang Yong, Li Dong, Fei Qi
Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
BMC Surg. 2020 Sep 14;20(1):200. doi: 10.1186/s12893-020-00860-2.
Staphylococcus caprae (Sc) is an uncommon causative organism for human. Lumbar pyogenic spondylodiscitis (LPS) of Sc is extremely rare and only a few cases have been reported. As far as we know, there is no specific literature on the diagnosis and treatment for LPS of Sc with L5 nerve root irritation.
A 65-year-old male patient complained of chronic low back pain for 10 years, acute worsening with radiating pain to left lower extremity over a month. Physical examination revealed tenderness point on his low back, 3/5 dorsiflexor strength in his left 1st toe and decreased sensation of pin prick over the left lateral shank and medial dorsal foot. The individual was initially misdiagnosed with lumbar disc herniation (LDH) without further examination in outpatient, which was then found to be LPS of Sc with L5 nerve root irritation after admission to our hospital. Magnetic resonance images (MRI) of lumbar spine exhibited inflammation signal at L4-L5 level of the vertebral body and disc with hypointense on T1-weighted images (T1-WI) and hyperintense on T2-weighted images (T2-WI). The causative organism was confirmed by the culture of irrigation fluid obtained from L5 vertebrae by needle puncture. After systemic conservative treatment including using sensitive antimicrobial agents and immobilization, the rare infection was finally cured. The patient also showed a satisfactory recovery during the 36-month follow-up period.
Confirming the diagnosis and identifying the causative organism as soon as possible is the key point for the treatment of LPS. LPS of Sc causing nerve root irritation is rare but curable with early diagnosis and proper therapy. The culture of irrigation fluid obtained from vertebrae by needle puncture may be an effective and sensitive attempt for potential infection of spine to identify the causative organism at early stage of the disease.
山羊葡萄球菌（Sc）是人类罕见的病原体。Sc引起的腰椎化脓性脊椎间盘炎（LPS）极为罕见，仅有少数病例报道。据我们所知，尚无关于伴有L5神经根刺激症状的Sc所致LPS诊断和治疗的具体文献。
一名65岁男性患者主诉慢性腰痛10年，近一个月急性加重并向左下肢放射痛。体格检查发现其腰部有压痛点，左足拇趾背屈肌力3/5，左小腿外侧和足背内侧针刺觉减退。该患者最初在门诊未进一步检查，被误诊为腰椎间盘突出症（LDH），入院后发现是伴有L5神经根刺激症状的Sc所致LPS。腰椎磁共振成像（MRI）显示L4 - L5椎体和椎间盘水平有炎症信号，在T1加权像（T1 - WI）上呈低信号，在T2加权像（T2 - WI）上呈高信号。通过对L5椎体穿刺获取的冲洗液进行培养，确诊了病原体。经过包括使用敏感抗菌药物和制动在内的全身保守治疗，这种罕见感染最终得以治愈。在36个月的随访期内，患者也显示出满意的恢复情况。
尽快确诊并确定病原体是LPS治疗的关键。Sc所致伴有神经根刺激症状的LPS虽罕见，但早期诊断和恰当治疗可治愈。通过对椎体穿刺获取的冲洗液进行培养，可能是在脊柱潜在感染疾病早期识别病原体的一种有效且敏感的尝试。
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